右美托咪定与丙泊酚对颅脑外伤患者的镇静效果、血流动力学及脑保护作用比较

Comparison of the effects of dexmedetomidine and propofol on sedation, hemodynamics and cerebral protection in patients with craniocerebral injury

摘要:

目的?比较右美托咪定与丙泊酚对颅脑外伤患者的镇静效果、血流动力学及脑保护作用。 方法?选取2017年1月—2019年12月在东部战区总医院秦淮医疗区住院治疗的颅脑外伤患者76例，采用随机数字表法分为对照组与观察组，每组38例。对照组给予丙泊酚，观察组给予右美托咪定。监控患者用药前（T1）、用药后2?h（T2）、用药后6?h（T3）及用药后24?h（T4）的格拉斯哥昏迷评分（GCS）、面部表情分级评分（FRS）、心率（HR）、平均动脉压（MAP）及血氧饱和度（SpO2），测定患者中心静脉氧饱和度（ScVO2）、颈内静脉氧饱和度（SjVO2）、血乳酸（Lac）、血清S100β蛋白及神经元特异性烯醇化酶（NSE）水平。记录患者用药期间不良反应发生情况。结果?观察组与对照组在T1、T2、T3、T4不同时间点的GCS、FRS评分有差别（P?<0.05）；观察组比对照组用药后GCS评分高，而FRS评分低（P?<0.05）；两组的GCS、FRS评分变化趋势有差别（P?<0.05）。观察组与对照组在T1、T2、T3、T4不同时间点的HR、MAP有差别（P?<0.05），而SpO2无差别（P?>0.05）；观察组比对照组用药后HR、MAP低（P?<0.05），而SpO2无差别（P?>0.05）；两组的HR、MAP变化趋势有差别（P?<0.05），而SpO2无差别（P?>0.05）。观察组与对照组在T1、T2、T3、T4不同时间点的ScVO2、SjVO2、Lac、NSE及S100β蛋白有差别（P?<0.05）；观察组比对照组用药后ScVO2、SjVO2水平高，而Lac、NSE及S100β水平低（P?<0.05）；两组的ScVO2、SjVO2、Lac、NSE及S100β蛋白水平变化趋势有差别（P?<0.05）。观察组与对照组不良反应总发生率比较，差异无统计学意义（P?>0.05）。 结论?右美托咪定可以有效地提升颅脑外伤患者的镇静、镇痛效果。其在维持血流动力学稳定的同时，能够有效地降低脑代谢、保护脑细胞，安全性高，具有重要的临床应用价值。

Abstract:

Objective To compare the effects of dexmedetomidine (Dex) and propofol on sedation, hemodynamics and cerebral protection in patients with craniocerebral injury. Methods A total of 76 patients with craniocerebral injury in our hospital from January 2017 to December 2019 were selected, and were divided into the control group (n?=?38) and the observation group randomly (n?=?38). The control group was given propofol, while the observation group was given Dex. The Glasgow coma score (GCS), face rating scale (FRS) score, heart rate (HR), mean arterial pressure (MAP), blood oxygen saturation (SpO2), the central venous oxygen saturation (ScVO2), internal jugular venous oxygen saturation (SjVO2), blood lactic acid (Lac), serum S100β protein, and neuron specific enolase (NSE) levels were measured before administration (T1), 2h after administration (T2), 6h after administration (T3), and 24h after administration (T4). The adverse reactions were recorded during the medication administration. Results The GCS and FRS score of the observation group were different from those of the control group at T1, T2, T3 and T4 (P??0.05) of the observation group were different from those of the control group at T1, T2, T3, T4. Compared with the control group, the HR and MAP of the observation group was lower (P??0.05). The changing trends of HR and MAP of the two groups were different (P??0.05). The ScvO2, SjvO2, Lac, NSE and S100β protein levels in the observation group were different from those in the control group at T1, T2, T3 and T4 (P??0.05). Conclusions Dex can effectively improve the effect of sedation and analgesia on patients with craniocerebral injury, which is beneficial to maintain the stability of hemodynamics, and is of significant value for clinical application.