右美托咪定用于重症颅脑损伤患者的效果观察
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摘要
目的:评价右美托咪定在重症颅脑损伤患者治疗中的作用,为临床重症颅脑损伤患者镇静方案的选择提供参考。方法:选择2017年4月至2018年4月石家庄市第一医院重症加强护理病房(intensive care unit,ICU)收治的中重度颅脑损伤患者160例,按照就诊顺序编号,采用数字随机表法分为对照组和观察组,每组80例。对照组患者采用咪达唑仑镇静镇痛,观察组患者采用右美托咪定镇静镇痛。比较两组患者入住ICU后24、48和72 h的心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、动脉氧分压(PaO_2)、动脉二氧化碳分压(PaCO_2)、甘露醇用量、停止输注镇静剂后唤醒时间(Richmond镇静躁动评分恢复到0分的时间)和唤醒前后格拉斯哥昏迷评分(glasgow coma scale,GCS);随访3～6个月,比较两组患者恢复优良率。结果:两组患者入住ICU后24、48和72 h的HR、RR、MAP、PaO_2及PaCO_2均较入住即刻有显著改善,且观察组患者改善程度明显优于对照组,差异有统计学意义(P<0.05);观察组患者入住ICU后24、48和72 h的甘露醇用量明显低于对照组,差异有统计学意义(P<0.05);观察组患者唤醒时间明显短于对照组,唤醒前后GCS评分的差值明显低于对照组,差异均有统计学意义(P<0.05);随访3～6个月,观察组患者恢复优良率明显高于对照组,差异有统计学意义(P<0.05)。结论:采用右美托咪定对重症颅脑损伤患者实施镇静镇痛,其镇静效果明显优于咪达唑仑,可有效提高患者近期预后质量,提高治疗的安全性。
OBJECTIVE: To evaluate the effects of dexmedetomidine in treatment of patients with severe craniocerebral injury,so as to provide references for the selection of sedation therapy. METHODS: 160 patients with moderate/severe craniocerebral injury admitted into ICU in the First Hospital of Shijiazhuang from Apr. 2017 to Apr. 2018 were selected and divided into control group and observation group according to the admission sequences, with 80 cases in each group. The control group was treated with midazolam for sedation and analgesia, while the observation group was given dexmedetomidine. Differences in heart rates(HR), respiratory rates(RR), mean arterial pressure(MAP), partial pressure of arterial oxygen(PaO_2), partial pressure of arterial carbon dioxide(PaCO_2), dosage of mannitol, wake-up time after stopping the infusion of sedatives(the time when the Richmond sedation score was restored to 0 point) and Glasgow coma scale(GCS) before and after wake-up at 24 h, 48 h and 72 h after ICU admission between two groups were compared; during follow-up for 3-6 months, the recovery rates of two groups were compared. RESULTS: At 24 h, 48 h and 72 h after ICU admission, the HR, RR, MAP, PaO_2 and PaCO_2 of both groups had been significantly improved than those of right after admission, and those of observation group were significantly better than the control group, with statistically significant differences(P<0.05); the dosages of mannitol of observation group at 24 h, 48 h and 72 h after ICU admission were significantly lower than those of the control group, with statistically significant differences(P<0.05); the wake-up time of observation group was significantly shorter than that of the control group, with significantly lower difference value of GCS between before and after wake-up, with statistically significant differences(P<0.05); during follow-up for 3-6 months, the recovery rate of observation group was significantly higher than that of the control group, with statistically significant difference(P<0.05). CONCLUSIONS: The sedative effect of dexmedetomidine for sedation and analgesia in patients with severe craniocerebral injury is significantly better than that of midazolam, which can effectively improve short-term prognosis and safety.
OBJECTIVE: To evaluate the effects of dexmedetomidine in treatment of patients with severe craniocerebral injury,so as to provide references for the selection of sedation therapy. METHODS: 160 patients with moderate/severe craniocerebral injury admitted into ICU in the First Hospital of Shijiazhuang from Apr. 2017 to Apr. 2018 were selected and divided into control group and observation group according to the admission sequences, with 80 cases in each group. The control group was treated with midazolam for sedation and analgesia, while the observation group was given dexmedetomidine. Differences in heart rates(HR), respiratory rates(RR), mean arterial pressure(MAP), partial pressure of arterial oxygen(PaO_2), partial pressure of arterial carbon dioxide(PaCO_2), dosage of mannitol, wake-up time after stopping the infusion of sedatives(the time when the Richmond sedation score was restored to 0 point) and Glasgow coma scale(GCS) before and after wake-up at 24 h, 48 h and 72 h after ICU admission between two groups were compared; during follow-up for 3-6 months, the recovery rates of two groups were compared. RESULTS: At 24 h, 48 h and 72 h after ICU admission, the HR, RR, MAP, PaO_2 and PaCO_2 of both groups had been significantly improved than those of right after admission, and those of observation group were significantly better than the control group, with statistically significant differences(P<0.05); the dosages of mannitol of observation group at 24 h, 48 h and 72 h after ICU admission were significantly lower than those of the control group, with statistically significant differences(P<0.05); the wake-up time of observation group was significantly shorter than that of the control group, with significantly lower difference value of GCS between before and after wake-up, with statistically significant differences(P<0.05); during follow-up for 3-6 months, the recovery rate of observation group was significantly higher than that of the control group, with statistically significant difference(P<0.05). CONCLUSIONS: The sedative effect of dexmedetomidine for sedation and analgesia in patients with severe craniocerebral injury is significantly better than that of midazolam, which can effectively improve short-term prognosis and safety.
引文
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[14] Li CH,Huang LN,Zhang MC,et al.Forensic Psychiatric Assessment for Organic Personality Disorders after Craniocerebral Trauma[J].Fa Yi Xue Za Zhi,2017,33(2):158-161.
[15] 刘建荣,王妮,唐小璐,等.集束化护理干预在重型颅脑损伤后躁动患者中的临床应用效果[J].广西医科大学学报,2017,34(4):636-640.
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[17] 成贤.右美托咪定对气管插管重症颅脑损伤患者镇静效果[J].中国继续医学教育,2018,10(15):67-69.
[18] 刘朋,刘暌,郝继山.右美托咪定在中型颅脑损伤患者镇静治疗中的应用[J].创伤外科杂志,2017,19(5):358-362.
[2] 赵娜.右美托咪定对重症颅脑损伤患者炎症因子和颅内压的影响[J].中国乡村医药,2014,21(21):12-14.
[3] Pajoumand M,Kufera JA,Bonds BW,et al.Dexmedetomidine as an adjunct for sedation in patients with traumatic brain injury[J].J Trauma Acute Care Surg,2016,81(2):345-351.
[4] 赵娜.右美托咪定对重症颅脑损伤患者内皮素-1的影响分析[J].中国高等医学教育,2014(7):134-135.
[5] 陈彩.重症颅脑损伤患者程序化镇痛镇静治疗与护理干预方法研究[J].基层医学论坛,2016,20(16):2288-2289.
[6] 祁绍艳,刘晓静,王文涛,等.舒芬太尼联合丙泊酚在重症颅脑损伤患者镇痛镇静中的应用[J].中国实用神经疾病杂志,2016,19(8):126-127.
[7] Frush DP,Lungren MP.The Image Gently Think A-Head Campaign: Keep Calm and Image Gently[J].J Am Coll Radiol,2017,14(2):301-302.
[8] 周建新.重症颅脑损伤患者镇痛镇静治疗的思考[J].中华医学信息导报,2015,30(3):19.
[9] 王立江,王立勋,李政荣,等.丙泊酚配合无创颅内压监护治疗重症颅脑损伤临床研究[J].现代中西医结合杂志,2017,26(13):1444-1446.
[10] Sherrard LJ.Clear andcalmmeasures[J].Occup Health Saf,2014,83(12):38-39.
[11] 李利.重症颅脑损伤患者程序化镇痛镇静治疗与护理干预方法[J].疾病监测与控制,2015,9(10):753-754.
[12] Suwal S,Karki S,Mandal D,et al.Computed Tomographic Evaluation of Craniocerebral Trauma in Dhulikhel Hospital[J].Kathmandu Univ Med J(KUMJ),2017,15(57):71-74.
[13] 吕刚.咪达唑仑、异丙酚镇静对颅脑损伤患者垂体前叶激素水平的影响分析[J].中国当代医药,2014,21(13):73-74,80.
[14] Li CH,Huang LN,Zhang MC,et al.Forensic Psychiatric Assessment for Organic Personality Disorders after Craniocerebral Trauma[J].Fa Yi Xue Za Zhi,2017,33(2):158-161.
[15] 刘建荣,王妮,唐小璐,等.集束化护理干预在重型颅脑损伤后躁动患者中的临床应用效果[J].广西医科大学学报,2017,34(4):636-640.
[16] 李杰,李岩.颅脑损伤丙泊酚与右美托咪定镇静治疗[J].中国临床神经外科杂志,2017,22(9):654-655.
[17] 成贤.右美托咪定对气管插管重症颅脑损伤患者镇静效果[J].中国继续医学教育,2018,10(15):67-69.
[18] 刘朋,刘暌,郝继山.右美托咪定在中型颅脑损伤患者镇静治疗中的应用[J].创伤外科杂志,2017,19(5):358-362.