早期目标导向镇静对重症脑出血术后颅内压及脑氧代谢的影响

Effect of early goal-directed sedation on intracranial pressure and cerebral oxygen metabolism after serious cerebral hemorrhage surgery

目的观察早期目标导向镇静(early goal directed sedation,EGDS)对重症脑出血(serious cerebral hemorrhage,SCH)术后颅内压及脑氧代谢的影响,为后续SCH治疗提供新思路。方法纳入湘西土家族苗族自治州人民医院收治的105例SCH患者,随机分为观察组(53例)和对照组(52例)。对照组给予常规镇静方案,观察组给予EGDS镇静方案。比较2组镇静前(T1)、镇静24 h(T2)、镇静48 h(T3)、镇静72 h(T4)的脑氧代谢相关指标;比较2组各时点的心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、脑灌注压(cerebral perfusion pressure,CPP)、颅内压(intracranial pressure,ICP)。结果2组动脉血乳酸(lactic acid,Lac)随着时间的推移呈降低趋势,脑氧摄取率(cerebral extraction rate of oxygen,CERO_(2))和脑动脉-静脉血氧含量差(cerebral arteriovenous blood oxygen content difference,a-vDO_(2))呈波动趋势,先降低后升高后降低,颈内静脉血氧饱和度(jugular venous oxygen saturation,SjvO_(2))和脑动脉血氧含量(cerebral arterial oxygen content,CaO_(2))呈升高趋势,观察组变化趋势比对照组更明显,2组组间、时点间、组间·时点间交互作用比较差异有统计学意义(P<0.05)。观察组随着时间的推移,HR呈现波动趋势,先降低后升高后降低,对照组HR呈现下降趋势,2组MAP呈现波动趋势,观察组HR、MAP变化趋势较对照组平缓,2组HR、MAP组间、时点间比较差异有统计学意义(P<0.05),HR组间·时点间交互作用比较差异有统计学意义(P<0.05),MAP组间·时点间交互作用比较差异无统计学意义(P>0.05)。2组ICP随着时间推移呈现增高趋势,CPP呈现波动趋势,2组组间比较差异有统计学意义(P<0.05),时点间、组间·时点间交互作用比较差异无统计学意义(P>0.05)。结论EGDS镇静方案可更加有效改善SCH患者的脑氧代谢、ICP和CPP,也可更加精准维持患者血流动力学处于浅镇静状态。

Objective To observe the effect of early goal-directed sedation(EGDS)on intracranial pressure and cerebral oxygen metabolism after serious cerebral hemorrhage(SCH),and to provide a new idea for the follow-up treatment of SCH.Methods A total of 105 patients with SCH who were admitted to People′s Hospital of Xiangxi Tujia and Miao Autonomous Prefecture were included,and randomly divided into the observation group(n=53)and the control group(n=52).The control group was given routine sedation,and the observation group was given EGDS.The indexes related to cerebral oxygen metabolism before sedation(T1),at 24 h after sedation(T2),at 48 h after sedation(T3),at 72 h after sedation(T4)were compared between the two groups.The heart rate(HR),mean arterial pressure(MAP),cerebral perfusion pressure(CPP)and intracranial pressure(ICP)at each time point were compared between the two groups.Results Arterial blood lactate(Lac)of the two groups showed a decreasing trend over time,while cerebral extraction rate of oxygen(CERO_(2))and cerebral arteriovenous blood oxygen content difference(a-vDO_(2))showed a fluctuating trend,first decreasing,then increasing,and then decreasing.Juglar venous oxygen saturation(SjvO_(2))and cerebral arterial oxygen content(CaO_(2))showed an increasing trend,and the observation group showed more significant changes than the control group.There was a significant difference in the interaction between groups,time points and time points between groups(P<0.05).Over time,the HR of the observation group showed a fluctuating trend,first decreasing,then increasing,and then decreasing.The HR of the control group showed a decreasing trend,while the MAP of the two groups showed a fluctuating trend.The changes in HR and MAP of the observation group were smoother than those of the control group.There were significant differences in interaction between groups and time points with respect to HR and MAP between the two groups(P<0.05).There was a significant difference in interaction between groups and time points with respect to HR(P<0.05),while there was no significant difference in interaction between groups and time points with respect to MAP(P>0.05).The ICP of the two groups showed an increasing trend over time,while CPP showed a fluctuating trend.There was a significant difference in interaction between the two groups(P<0.05),while there was no significant difference in the interaction between time points,or between groups and time points(P>0.05).Conclusion The EGDS regimen can more effectively improve the cerebral oxygen metabolism,ICP,and CPP of SCH patients,and can also more accurately maintain the patient′s hemodynamics in a shallow sedation state.