重型颅脑损伤应用丙泊酚麻醉的效果分析

Analysis of the Effect of Propofol Anesthesia for Severe Traumatic Brain Injury

目的探析重型颅脑损伤(severe traumaic brain injury,sTBI)应用丙泊酚的麻醉效果。方法随机选择2020年8月—2022年8月盐城市大丰人民医院麻醉科就诊的80例sTBI患者,采用随机数表法分为两组,各40例。两组均接受去骨瓣减压术联合血肿清除治疗,对照组给予依托咪酯麻醉,观察组联合丙泊酚麻醉。对比两组镇静躁动情况[Ricker镇静-躁动评分量表(Sedation Agitation Scale,SAS)],麻醉诱导前、手术结束1 h颅内压、脑氧分压、心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)参数、神经生化标志物指标[神经元特异性烯醇化酶(neuron specific enolase,NSE)、S100β]以及麻醉苏醒期不良反应发生率。结果术后2 h两组SAS镇静躁动评分明显降低,且观察组SAS镇静躁动评分(2.69±1.06)分低于对照组(4.18±1.22)分,差异有统计学意义(t=5.831,P<0.05)。麻醉后两组颅内压明显降低,脑氧分压明显升高,MAP水平小幅度上升,且观察组颅内压(16.24±5.22)mmHg、HR(73.44±10.19)次/min、MAP(86.44±10.24)mmHg低于对照组(22.49±5.31)mmHg、(78.45±10.36)次/min、(92.15±10.67)mmHg,脑氧分压(16.23±2.68)mmHg高于对照组(12.34±2.57)mmHg,差异有统计学意义(t=5.309、2.183、2.442、6.626,P<0.05)。麻醉前两组NSE、S100β指标对比,差异无统计学意义(P>0.05);麻醉后两组NSE、S100β明显升高,且观察组NSE、S100β低于对照组,差异有统计学意义(t=3.333、2.548,P<0.05)。两组麻醉苏醒期不良反应率(10.00%、22.50%)对比,差异无统计学意义(χ^(2)=2.296,P>0.05)。结论丙泊酚应用于sTBI中麻醉效果显著,具有良好镇静功效,可降低颅内压,升高脑氧分压,稳定血流动力学参数,保护脑神经功能,且麻醉安全性较高,值得临床推广。

Objective To explore the anesthetic effect of applying propofol in severe traumaic brain injury(sTBI).Methods Eighty patients with sTBI attending the Department of Anesthesiology of Yancheng Dafeng People's Hospital from August 2020 to August 2022 were randomly selected and divided into two groups of 40 patients each using the random number table method.Both groups received debridement decompression combined with hematoma removal treatment,and etomidate anesthesia was given to the control group and propofol anesthesia was combined with the observation group.The sedation agitation[Sedation Agitation Scale(SAS)],intracranial pressure before induction of anesthesia and at the end of surgery(1 h),partial pressure of cerebral oxygen,heart rate(HR),mean arterial pressure(MAP)parameters,neurological markers[neuron specific enolase(NSE),S100β],and the rate of adverse reactions during anesthesia awakening were compared between the two groups.Results The SAS sedation agitation score was significantly lower in both groups 2 h after surgery,and the SAS sedation agitation score in the observation group(2.69±1.06)points was lower than that in the control group(4.18±1.22)points,and the difference was statistically significant(t=5.831,P<0.05).After anesthesia,intracranial pressure was significantly lowered,partial pressure of cerebral oxygen were significantly higher,and MAP levels increased slightly in both groups,and the intracranial pressure(16.24±5.22)mmHg,HR(73.44±10.19)beats/min and MAP(86.44±10.24)mmHg in the observation group were lower than those in the control group(22.49±5.31)mmHg,(78.45±10.36)beats/min and(92.15±10.67)mmHg,and partial pressure of cerebral oxygen(16.23±2.68)mmHg was higher than that of the control group(12.34±2.57)mmHg,and the difference was statistically significant(t=5.309,2.183,2.442,6.626,P<0.05).There was no statistically significant difference between the NSE and S100βindexes of the two groups before anesthesia(P>0.05).After anesthesia,NSE and S100βincreased significantly in both groups,and NSE and S100βin the observation group were lower than those in the control group,and the difference was statistically significant(t=3.333,2.548,P<0.05).There was no statistically significant difference in the rate of adverse reactions during the awakening period of anesthesia(10.00%,22.50%)between the two groups(χ^(2)=2.296,P>0.05).Conclusion The application of propofol in sTBI has significant anesthetic effect,good sedative efficacy,can reduce intracranial pressure,increase cerebral oxygen partial pressure,stabilize hemodynamic parameters,protect cerebral neurological function,and has high anesthetic safety,which is worthy of clinical promotion.