右美托咪定联合地佐辛在自发性脑出血开颅术后镇静、镇痛中的疗效观察

目的 探讨右美托咪定联合地佐辛对自发性脑出血开颅术后镇静、镇痛的临床疗效。方法 回顾性分析2017年9月至2018年9月开颅血肿清除术治疗的符合标准的56例SICH的临床资料。根据术后镇静、镇痛方式分成观察组（28例）和对照组（28例）。观察组采用右美托咪定联合地佐辛治疗，对照组采用咪达唑仑联合地佐辛治疗。结果 用药后2、6、12、24 h，观察组镇静Ramsay评分、镇痛视觉模拟量表（VAS）评分、恶心呕吐AVS评分、平均动脉压、心率较对照组均明显降低（P<0.05），而SpO2均明显提高（P<0.05）。观察组住院时间（19.86±3.76）d]较对照组（23.61±5.78）d]明显缩短（P<0.05）。观察组再出血率（3.57%，1/28）与对照组（10.71%，3/28）无统计学差异（P>0.05）。结论 右美托咪定联合地佐辛对自发性脑出血开颅术后病人具有良好的镇静、镇痛作用，能够稳定术后血流动力学指标，减少住院时间。

Effect of dezocine combined with dexmedetomidine on the analgesia and sedation after craniotomy in patients with spontaneous intracerebral hemorrhage

Objective To explore the effect of dezocine combined with dexmedetomidine on the analgesia and sedation after craniotomy in the patients with spontaneous intracerebral hemorrhage (SICH). Methods Of 56 patients with SICH who underwent craniotomy for evacuation of hematomas in our hospital from September, 2017 to September, 2018, 28 (observation group) were treated with dexmedetomidine and dezocine, and 28 (control group) were treated with dezocine and midazolam. The Ramsay sedation score, the score of analgesia visual analogue scale (VAS) and nausea and vomiting VAS, mean arterial pressure (MAP), heart rate (HR), blood oxygen saturation (SPO2), rebleeding rate and the length of hospital stays were compared between both the groups. Results The Ramsay sedation scores and SPO2 were significantly higher in the observation group than that in the control group 2, 6, 12 and 24 hours after the treatment (P<0.05). The scores of analgesia VAS and nausea and vomiting VAS, MAP and HR were significantly lower than those in the control group 2, 6, 12 and 24 hours after the treatment (P<0.05). MAP and HR were significantly lower in the observation group in the observation group after the treatment than those before the treatment in the observation group (P<0.05). SpO2 was significantly higher after the treatment than that before the treatment in the observation group (P<0.05). There was insignificantly difference in the rebleeding rate between both the groups (P>0.05). The hospital stays was significantly shorter in the observation group than that in the control group (P<0.05). Conclusions Dexmedetomidine combined with dezocine has significantly effect on analgesia and sedation and can stabilize postoperative hemodynamic parameters and reduce hospital stays in the patients with SICH undergoing craniotomy.