镇静镇痛对重型颅脑损伤患者术后颅内压的影响分析

目的探讨镇静镇痛对重型、特重型颅脑损伤（TBI）患者术后颅内压（ICP）的影响。 方法选取湖州市第一人民医院神经外科自2016年1月至2018年6月收治的重型TBI患者45例，根据GCS评分将患者分为重型TBI组（GCS评分6~8分，26例）与特重型TBI组（GCS评分3~5分,19例），观察2组镇静镇痛下及撤除镇静镇痛/唤醒下ICP值波动情况。 结果特重型TBI患者在镇静镇痛前后ICP差异无统计学意义（P>0.05），重型TBI患者撤除镇静镇痛/唤醒后，ICP前后变化差异有统计学意义（P<0.05）。 结论镇痛镇静与重型TBI开颅术后颅内压力波动有显著相关性，使用镇静镇痛可获得安全、平稳的ICP。

Effects of sedation and analgesia on postoperative intracranial pressure in patients with severe traumatic brain injury

ObjectiveTo investigate the effect of sedation and analgesia on intracranial pressure (ICP) in patients with severe and severest traumatic brain injury(TBI). MethodsForty-five patients with severe TBI admitted to Department of Neurosurgery of Huzhou First People’s Hospital from January 2016 to June 2018 were divided into severe TBI group (GCS scores 6-8, 26 cases) and severest TBI (GCS scores 3-5, 19 cases) according to GCS score. Observing ICP value fluctuations under sedative and analgesia or withdrawal of sedative and analgesia/awake. ResultsThere was no significant difference in ICP between patients with severest TBI before and after sedation and analgesia (P>0.05). There was a significant difference in ICP changes before and after sedation and analgesia in patients with severe TBI(P<0.05). ConclusionAnalgesia and sedation are significantly correlated with intracranial pressure fluctuations after craniotomy operation for severe TBI. In severe TBI group, safe and stable ICP can be obtained by controlling sedation and analgesia.