摘要
目的探讨机械通气治疗的老年颅脑损伤患者应用丙泊酚和咪达唑仑镇静对垂体前叶激素皮质醇分泌的影响。方法将64例（年龄65～72岁）行机械通气的老年颅脑损伤患者分为两组：丙泊酚组（32例）和咪达唑仑组（32例）。记录患者重症加强护理病房（ICU）镇静全程的血流动力学参数、颅内压和脑灌注压，采用酶联免疫吸附法（ELISA）检测患者人住ICU后24h、72h和4周时静脉血的垂体前叶激素皮质醇水平。结果两组患者ICU期间脉搏氧饱和度、腋温、呼气末二氧化碳分压、心率、平均动脉压、颅内压和脑灌注压差异无统计学意义（P〉0．05）。丙泊酚组血清皮质醇含量在24h和72h时[（269．7±43．2）nmol／L、（234．962±66．9）nmol／L3；低于咪达唑仑组[（278．0±75．5）nmol／L、（243．2±42．4）nmol／L3（t=5．312和5．919，均P=0．000）；皮质醇在第4周时丙泊酚组为（209．1±73．9）nmol／L，咪达唑仑组（210．8±66．6）nmol／L，两组间比较差异无统计学意义（t=0．075，P=0．938）。结论丙泊酚与咪达唑仑对ICU内老年颅脑损伤患者早期的皮质醇分泌有差异。
Objective To compare the effects of propofol versus midazolam on serum hydrocortisone in the aged traumatic brain injury. Methods 64 patients （aged 65-72 years） with traumatic brain injury during mechanical ventilation were divided into propofol group （n= 32） and midazolam group（n =32）. The hemodynamies data, intracranial pressure（ICP） and the calculated cerebral perfusion pressure（CPP） were recorded. The serum hydrocortisone of patients was detected by enzyme linked immunosorbent assay （ELISA） at 24 h, 72 h and 4 weeks in intensive care unit （ICU）. Results There was no differences in partial pressure of carbon dioxide, heart rate, mean artery pressure, pulse blood oxygen saturation （SpO2）, armpit temperature, endexpiratory gas（PET CO2）, intraeranial pressure （ICP） and cerebral perfusion pressure （CPP） between the two groups （P〉0.05）. The serum hydrocortisone in propofol group at 24 h and 72 h [（269. 7±43. 2） nmol/L and （235.0±67.0） nmol/L] were lower than in midazolam group [（278.0±75.5） nmol/L and （243.2± 42.4） nmol/L] （t= 5. 312 and 5. 919, both P= 0. 000）. The serum hydrocortisone in propofol and midazolam group at 4 weeks were （209.1±73.9） nmol/L and （210.8±66.6） nmol/L, respectively, no significant difference was found （t = 0. 075, P = 0. 938）. Conclusions There is a significant difference in the effects of propofol and midazolam on the early level of hydrocortisone in the aged patients with traumatic brain injury.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2012年第3期208-210,共3页
Chinese Journal of Geriatrics
关键词
深度镇静
颅脑损伤
四氢皮质醇
Deep sedation
Cranioeerebral trauma
Tetrahydrocortisol
