右旋美托咪定在轻中度颅脑损伤术后患者中的镇静效果及对颅内压的影响

Effect of dexmedetomidine on sedation and intracranial hypertension of patients with mild to moderate traumatic brain injury after operation

目的观察右旋美托咪定在轻中度颅脑损伤患者术后镇静中的临床效果。方法选择符合纳入标准的180例轻中度颅脑损伤患者作为研究对象,采用随机数字表法将其分为右旋美托咪定组(A组)、丙泊酚组(B组)和咪唑安定组(C组)。观察并记录患者术后用药前(T1),用药后1 h(T2)、6 h(T3)、12 h(T4)、12 h(T5)、24 h(T6)的Richmond躁动-镇静(Richmond Agitation and Sedation Scale,RASS)评分、颅内压(intracranial pressure,ICP)值、脑灌注压的变化情况及低血压、心动过缓的发生情况。结果A组、B组和C组在T1~T3的RASS评分和CPOT评分无显著差异(P>0.05)。A组和B组在T4~T6的RASS得分和CPOT得分显著低于C组(P>0.05)。T4~T6时A组和B组的最佳镇静比例(RASS评分在-2~+1)显著高于C组(P>0.05)。同一时间点B组的过度镇静比例(RASS评分<-2)高于A组(P>0.05)。C组在同一时间点的激动比例(RASS评分>+1)高于A组和B组(P>0.05)。A组和B组在T3~T5时的ICP值显著低于C组(P>0.05),且A组和C组在所有时间点的lCP值均无差异。三组在所有时间点的CPP(P=0.06)和低血压和心动过缓的发生率(P=0.015)均无差异。结论右旋美托咪啶在轻中度颅脑损伤患者术后中的镇静疗效安全可靠,更易于使镇静程度控制在理想范围内(RASS评分处于-2~+1分)。

Methods To explore the sedative effect of dexmedetomidine on patients with mild to moderate traumatic brain injury after operation and on intracranial pressure(ICP).Methods A total of 180 patients with mild to moderate traumatic brain injury meeting designed inclusion criteria were enrolled as study subjects,and were divided into group A(dexmedetomidine),group B(dexmedetomidine+propofol),and group C(midazolam)by the random number table method.The Richmond Agitation Sedation Scale(RASS)score,ICP,changes of cerebral perfusion pressure(CPP),and occurrence of hypotension and bradycardia were recorded before surgery(T1),1 h(T2),2 h(T3),6 h(T4),12 h(T5),and 24 h(T6)after surgery.Results The RASS scores and Critical-care Pain Observation Tool(CPOT)scores of group A,group B,and group C at T1-T3 were not significantly different(P>0.05).The RASS score and CPOT scores of group A and group B at T4-T6 were significantly lower than those of group C(P>0.05).The proportions of optimal sedation(RASS score at-2 to+1)of group A and group B at T4-T6 were significantly higher than that of group C(P>0.05),the proportions of over sedation(RASS score<-2)of group B at the same time points were higher than those of group A(P>0.05),and the proportions of agitation(RASS score>+1)of group C at the same time points were higher than those of group A and group B(P>0.05).The ICP values of group A and group B at T3-T5 were significantly lower than the values of group C(P>0.05),and no difference in the lCP values were found between group A and group B at all time points.There was no difference in CPP at all time points(P=0.06)and the incidence rates of hypotension and bradycardia(P=0.15)among the three groups.Conclusion Dexmedetomidine produces a safe and reliable sedative effect on patients with mild to moderate traumatic brain injury after operation,and tends to achieve optimal sedation(RASS score at-2 to+1).