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    刘粉红, 韩康, 王巍, 张劲松. 右美托咪定、咪达唑仑对重型颅脑损伤术后脑氧代谢的影响[J]. 蚌埠医科大学学报, 2023, 48(10): 1378-1383. DOI: 10.13898/j.cnki.issn.1000-2200.2023.10.011
    引用本文: 刘粉红, 韩康, 王巍, 张劲松. 右美托咪定、咪达唑仑对重型颅脑损伤术后脑氧代谢的影响[J]. 蚌埠医科大学学报, 2023, 48(10): 1378-1383. DOI: 10.13898/j.cnki.issn.1000-2200.2023.10.011
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    LIU Fen-hong, HAN Kang, WANG Wei, ZHANG Jin-song. Effects of dexmedetomidine and midazolam on postoperative cerebral oxygen metabolism in patients with severe brain injury[J]. Journal of Bengbu Medical University, 2023, 48(10): 1378-1383. DOI: 10.13898/j.cnki.issn.1000-2200.2023.10.011
    Citation: LIU Fen-hong, HAN Kang, WANG Wei, ZHANG Jin-song. Effects of dexmedetomidine and midazolam on postoperative cerebral oxygen metabolism in patients with severe brain injury[J]. Journal of Bengbu Medical University, 2023, 48(10): 1378-1383. DOI: 10.13898/j.cnki.issn.1000-2200.2023.10.011
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    右美托咪定、咪达唑仑对重型颅脑损伤术后脑氧代谢的影响

    Effects of dexmedetomidine and midazolam on postoperative cerebral oxygen metabolism in patients with severe brain injury

      摘要
    • 摘要:
      目的探讨右美托咪定、咪达唑仑对重型颅脑损伤术后病人脑氧代谢的影响。
      方法选取30例重型颅脑损伤术后病人，随机分为右美托咪定组(n=15)与咪达唑仑组(n=15)。监测镇静前及镇静第1~5天的心率(HR)、平均动脉压(MAP)、格拉斯哥昏迷评分(GCS)、Richmond躁动-镇静评分(RASS)、脑氧摄取率和脑动静脉氧含量差，以及机械通气时间、ICU住院时间、总住院时间、28 d格拉斯哥预后评分。
      结果2组病人的年龄、性别、颅脑损伤类型、急性生理与慢性健康Ⅱ评分、GCS评分、术后RASS的差异均无统计学意义(P>0.05)。镇静前2组病人各指标差异均无统计学意义(P>0.05)；与咪达唑仑组比较，镇静后右美托咪定组第1~5天HR均下降，第4和5天MAP下降(P < 0.05~P < 0.01)。与镇静前比较，右美托咪定组镇静后第3~5天HR下降，第1~5天MAP下降(P < 0.05~P < 0.01)。与咪达唑仑组比较，右美托咪定组第1天和第2天氧合指数、颈静脉球血氧分压和颈静脉球血氧饱和度升高(P < 0.05~P < 0.01)，脑氧摄取率和脑动静脉氧含量差差异无统计学意义(P>0.05)。右美托咪定组机械通气时间较咪达唑仑组缩短(P < 0.05)。
      结论重型颅脑损伤病人术后使用右美托咪定镇静，较咪达唑仑能改善早期脑氧代谢水平、降低HR及MAP，缩短机械通气时间。

       

      Abstract:
      ObjectiveTo investigate the effects of dexmedetomidine and midazolam on postoperative cerebral oxygen metabolism in patients with severe brain injury.
      MethodsA total of 30 postoperative patients with severe brain injury were randomly divided into dexmedetomidine group (n=15) and midazolam group (n=15).The heart rate (HR), mean arterial pressure (MAP), Glasgow coma score (GCS), Richmond restless sedation score (RASS), cerebral oxygen uptake rate and cerebral arteriovenous oxygen content difference before sedation and from the first to the fifth day of sedation were monitored, as well as the mechanical ventilation time, ICU hospital stay, total hospital stay, and 28-day Glasgow prognosis score.
      ResultsThere were no differences in age, gender, type of brain injury, Acute Physiology Age and Chronic Health Evaluation II score, GCS score and postoperative RASS score between the two groups (P>0.05).Before sedation, there were no significant differences in all indexes between the two groups (P>0.05).Compared with the midazolam group, the HR decreased on the first to fifth day in the dexmedetomidine group, and the MAP decreased on the fourth and fifth day (P < 0.05 to P < 0.01).Compared with that before sedation, HR decreased from the third day to the fifth day after sedation and MAP decreased from the first day to the fifth day after sedation in the dexmedetomidine group (P < 0.05 to P < 0.01).Compared with the midazolam group, the oxygenation index, jugular bulb venous oxygen pressure and jugular bulb venous oxygen saturation were increased in the dexmedetomidine group on the first day and second day after sedation (P < 0.05 to P < 0.01), and there was no statistical difference between cerebral oxygen uptake rate and cerebral arteriovenous oxygen content (P>0.05).The duration of mechanical ventilation was shortened in the dexmedetomidine group compared with that in the midazolam group (P < 0.05).
      ConclusionsCompared with midazolam, dexmedetomidine sedation can improve early cerebral oxygen metabolism, reduce HR and MAP, and shorten mechanical ventilation time in patients with severe craniocerebral injury.

       

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