镇痛镇静对重症蛛网膜下腔出血患者脑代谢的影响

目的:探讨研究镇痛镇静对重症蛛网膜下腔出血患者脑代谢的影响.方法:选择符合标准的55例重症蛛网膜下腔出血患者,使用枸橼酸芬太尼注射液、咪达唑仑注射液以及丙泊酚注射液进行镇痛镇静的治疗.测定患者在镇痛镇静前、镇痛镇静中以及镇痛镇静后患者颈动脉、颈静脉以及中心静脉血氧饱和度.结果:在镇痛镇静前,患者颈动脉、颈静脉以及中心静脉血氧饱和度分别为(0.86±0.19)、(0.46±0.07)、(0.48±0.05).镇痛镇静后2h,患者颈动脉血氧饱和度显著性下降(t=4.63,P<0.05);而颈静脉(t=7.62,P<0.05)与中心静脉(t=7.53,P<0.05)血氧饱和度显著性升高;在镇痛镇静结束后,患者颈动脉血氧饱和度呈现下降的趋势,颈静脉与中心静脉血氧饱和度呈现上升的趋势,三者接近镇痛镇静前的水平(P>0.05).结论:使用镇痛镇静剂对SAH患者进行治疗时,不仅能够降低患者的全身代谢,对患者脑氧代谢也有降低的作用.镇痛镇静能否改善患者的预后也需要进行深入研究.

Effect of Analgesia and Sedation on Cerebral Metabolism in Patients with Severe Subarachnoid Hemorrhage

Objective:To integrative clinical effect of analgesia and sedation on cerebral metabolism in patients with severe subarachnoid hemorrhage. Methods:55 patients with severe subarachnoid hemorrhage were chosen for this investigation. Fentanyl citrate injection, midazolam injection and propofol injection were used for the treatment of severe subarachnoid hemorrhage. The carotid, jugular and central venous oxygen sat-uration before, during and after analgesia and sedation treatment were detected. Results:Before sedation and analgesia treatment, the carotid, jugular and central venous blood oxygen saturation were (0.86±0.19), (0. 46±0.07) and (0.48±0.05). 2h after analgesia and sedation treatment started, carotid artery oxygen satura-tion decreased significantly (t=4.63, P < 0.05); while the jugular vein (t=7.62, P < 0.05) and central vein (t=7.53, P < 0.05) oxygen saturation increased significantly. After analgesia and sedation treatment, carotid artery oxygen saturation decreased, while jugular vein and central venous oxygen saturation increased, and the results had no significant difference with the results before treatment (P > 0.05). Conclusion:The use of analgesia and sedation treatment of patients with severe subarachnoid hemorrhage can not only reduce the body metabolism, but also reduce the cerebral metabolism. Whether analgesia and sedation treatment can improve the prognosis of severe subarachnoid hemorrhage needs further study.