摘要
目的评估右美托咪啶在中重度颅脑创伤（TBI）患者应激控制中的作用及其对神经内分泌功能的影响。方法2009年5月-2012年1月成都军区昆明总医院收治的TBI患者90例[格拉斯哥评分（GCS）6～13分1，依入院顺序随机分为3组，采用不同镇痛镇静方案。A组（n=32）：右美托眯啶负荷量0．5～1．0μg／kg，30min内注完，0．2～0．6μg／（kg．h）维持24h，效果不佳者加用吗啡静脉注射；B组（n=31）：异丙酚负荷量0．5～2．0mg／kg，10min注完，1．0～3．0mg／（kg．h）维持72h，效果不佳者加用吗啡静脉注射；C组（n=27）：空白组，采用哌替啶等肌内注射作为临时用药。采用Riker镇静和躁动评分，结合生理与躯体反应阳性指标进行综合评估，监测血压、心率、呼吸、潮气量以及动脉血气、血浆皮质醇、血浆β内啡肽（β-EP）、外周血白细胞计数（WβC）、血糖变化等，并进行组间比较。结果A、B、C组单独用药（即不加用吗啡时）的镇静有效率分别为86．7％、80．6％、77．8％，组间比较差异无统计学意义。与给药前比较，给药后0．5hA组平均动脉压（MAP）下降（P〈0．05），余各时间点3组血压、心率及呼吸功能与给药前比较无明显差异（P〉0．05）。给药后24h时间点A组WβC、C组皮质醇水平低于给药前，余各时间点3组WBC、血糖、皮质醇及β-EP水平与给药前比较无明显差异（P〉0．05）。结论右美托咪啶可控制中重度颅脑伤后的过度应激反应，其抗应激及镇静效果与异丙酚类似，但需监测血压变化。β-EP可能在右美托咪啶的早期作用中发挥协同作用。
Objective To investigate the role of dexmedetomidine in stress control in moderate and severe traumatic brain injury （TBI） and its influence on neuroendocrine system. Methods Ninety moderate or severe TBI patients （GCS 6-13） were admitted to ICU from May 2009 to January 2012, and they were divided into three groups according to the order of admission. Patients in group A （n=32） received 0.5-1.0μg/kg dexmedetomidine within 30min, maintained with 0.2-0.6μg/（kg.h） dexmedetomidine for 24h, and morphine was administered by intravenous injection when necessary; patients in group B （n=31） received a 0.S-2.0mg/kg loading dose of propofol within 10min, maintained with 1.0-3.0mg/（kg.h） for 72h, and morphine was administered by intravenous injection when necessary; patients in group C （n=27） received an intramuscular injection of pethidine or other optional drugs as control. A comprehensive evaluation was performed using Riker sedation-agitation scale combined with physiological and physical response indicators. The blood pressure, heart rate, respiration, tidal volume, arterial blood gas, plasma cortisol, plasma β-endorphin （β-EP）, peripheral WBC count and blood glucose were measured and compared in 3 groups. Results The sedation rate of single-drug （i.e., without morphine administration） in groups A, B and C was 86.7%, 80.6% and 77.8% respectively, and no significant difference was found among 3 groups （P〉0.05）. The mean arterial blood pressure at 30 rain after administration was lower than that before administration in group A （P〈0.05）, and the blood pressure, heart rate and respiratory function at other time points were similar to those before administration in the 3 groups （P〉0.05）. The WBC count and plasma cortisol level at 24h after treatment were lower than those before administration of the drugs in group A （P〈0.05）, and the WBC count, blood glucose, plasma cortisol and β-EP levels at other time points were similar to those before administration of the drugs in the 3 groups （P〉0.05）. Conclusions Dexmedetomidine could alleviate the stress as a result of moderate and severe TBI, and its anti-stress and sedative effects were similar to those of propofol, but it is necessary to monitor the blood pressure. β-EP may play a coordinating role in the early stage of effect of dexmedetomidine.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2013年第11期917-921,共5页
Medical Journal of Chinese People's Liberation Army
关键词
颅脑损伤
右美托咪啶
Β内啡肽
craniocerebral trauma
dexmedetomidine
beta-endorphin
