早期目标导向型镇静联合RASS评分在重度创伤性颅脑损伤病人中的应用

赵丽; 荣晓姗; 沈丽; 李道昌; 顾磊

doi:10.13898/j.cnki.issn.1000-2200.2019.08.036

早期目标导向型镇静联合RASS评分在重度创伤性颅脑损伤病人中的应用

Study on the early goal-directed sedation combined with RASS score in the application of patients with severe traumatic brain injury

摘要

摘要:
目的探讨早期目标导向型镇静（EGDS）策略联合RASS评分在重度创伤性颅脑损伤病人中的应用效果。
方法选择符合标准的74例重度创伤性颅脑损伤病人按随机数字法分为EGDS组和对照组。EGDS组中36例病人采用以盐酸右美托咪定注射液为主导的镇静药物实施EGDS策略；对照组中38例以咪达唑仑注射液为主导镇静药物实施常规镇静策略，镇静目标为维持RASS评分-2~1分，比较2组病人12 h内浅镇静的达标率和镇静治疗后第30 min及第1 h病人处于浅镇静状态的比例；比较2组镇静前、后平均动脉压、心率及呼吸频率变化。
结果持续镇静12 h，2组病人处于浅镇静、深镇静和烦躁的比例差异有统计学意义（P < 0.05）。在镇静治疗30 min时EGDS组浅镇静病人占全部浅镇静的比例为54.55%，高于对照组的13.33%（P < 0.05）；在镇静治疗1 h时EGDS组浅镇静病人占全部浅镇静的比例为77.27%，高于对照组的33.33%（P < 0.05）。用药前，2组平均动脉压、心率和呼吸频率差异无统计学意义（P>0.05）。用药后，2组病人呼吸频率和心率差异亦无统计学意义（P>0.05），但对照组的平均动脉压明显低于EGDS组（P < 0.05）。2组用药后呼吸频率和心率均较用药前明显降低（P < 0.01）。
结论早期目标导向型镇静联合RASS评分相对安全、可行，较常规镇静策略能更有效使重度创伤性颅脑损伤病人达到早期浅镇静目标，舒适度高，安静配合，对生命体征干预少，安全有效，在具有广泛的临床应用前景。

Abstract:
ObjectiveTo explore the effects of early goal-directed sedation(EGDS) strategy combined with RASS score in the application of patients with severe traumatic brain injury.
MethodsSeventy-four patients with severe traumatic brain injury were randomly divided into the EGDS group(36 cases) and control group(38 cases).The sedative drug dexmedetomidine hydrochloride injection was used to implement the EGDS strategy in EGDS group, the midazolam injection was used as the leading sedative for routine sedation in control group, and the sedation goal was to maintain a RASS score of -2 to 1.The rate of reaching the standard of light sedation within 12 hours and proportion of patients with light sedation after 30 minutes and 1 hour of sedation were compared between two groups.The mean arterial pressure, heart rate and respiratory rate between two groups were compared before and after sedation.
ResultsAfter 12 hours of continuous sedation, the differences of the proportions of light sedation, deep sedation and restlessness between two groups were statistically significant(P < 0.05).After 30 minutes of sedation treatment, the proportion of light sedation patients in EGDS group(54.55%) was higher than that in control group(13.33%)(P < 0.05).After 1h of sedation treatment, the proportion of light sedation patients in EGDS group(77.27%) was higher than that in control group(33.33%)(P < 0.05).There was no statistical significance in the mean arterial pressure, heart rate and respiratory frequency between two groups before treatment(P>0.05).There was no statistical significance in the heart rate and respiratory frequency between two groups after treatment(P>0.05), but the mean arterial pressure in control group was significantly lower than that in EGDS group(P < 0.05).After treatment, the respiratory frequency and heart rate in two groups were significantly lower than those before treatment(P < 0.01).
ConclusionsCompared with standardized sedation strategy, the early goal-directed sedation combined with RASS score in the application of patients with severe traumatic brain injury is relatively safe and feasible, can achieve early light sedation goals with high comfort, quiet coordination and less intervention for vital signs, and has extensive clinical application prospect in clinic.

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