右美托咪啶在重型颅脑外伤手术中的脑保护作用

目的探讨右美托咪啶对重型颅脑外伤患者躁动镇静的临床效果及手术麻醉中的脑保护作用。方法选取2014-12-2016-12驻马店市第一人民医院收住的重型颅脑外伤患者50例为试验组,均采取手术治疗,在常规麻醉诱导前给予右美托咪啶1.0μg/kg静脉注射,之后以0.5μg/(kg·h)维持至手术结束。同期50例患者为对照组,在麻醉诱导前给予咪唑安定0.1mg/kg,静注,之后以30μg/(kg·h)维持至手术结束。采用Ramsay镇静评分评估术后24h内患者镇静状态,并分别于术前、术后24h采用酶联免疫吸附法(ELISA)检测血浆S-100蛋白及神经元特异性烯醇化酶(NSE)水平,并检测脑氧摄取率(CERO_2)、动脉-颈内静脉血氧含量差(Da-jvO_2)以及颈静脉血氧饱和度(SjvO2)。结果试验组术后12h、24hRamsay评分分别为(3.2±0.6)分、(2.5±0.6)分,对照组分别为(3.9±0.7)分、(3.1±0.6)分,试验组不同时间点镇静效果均优于对照组(P0.05)。术前2组患者S-100蛋白、NSE、CERO_2、Da-jvO_2及SjvO_2水平差异无统计学意义(P0.05)。术后24h2组S-100蛋白、NSE、CERO_2及SjvO_2水平升高(P0.05),但试验组S-100蛋白、NSE、CERO_2、Da-jvO_2低于对照组(P0.05),SjvO_2高于对照组(P0.05)。结论术中应用右美托咪啶可提高重型颅脑损伤患者镇静效果,并改善脑氧代谢,均具有一定的脑保护作用。

Effect of dexmedetomidine in patients with severe craniocerebral trauma undergoing operation

Objective To investigate the clinical effect of dexmedetomidine on restlessness and sedation in patients with severe traumatic brain injury and the effect of anesthesia on brain protection.Methods 50 patients with severe craniocerebral trauma in the First People's Hospital of Zhumadian were selected from December 2014 to December 2016 as the experimental group and all treated with surgery,1.0 ug/kg intravenous injection of dexmedetomidine was given before routine anesthesia induction,and then 0.5 μg/(kg · h) was maintained until the end of operation.Another 50 patients in the same period were selected as the control group and treated with 0.1 mg/kg intravenous infusion of midazolam before induction of anesthesia,and then 30 μg/(kg · h) is maintained until the end of the operation.Sedation status was assessed within 24 hours by using the Ramsay sedation score.Serum S-100-beta protein and neuron specific enolase (NSE) levels were measured by using enzyme linked immunosorbent assay (ELISA) before and after surgery,respectively at 24h after operation.Cerebral oxygen uptake rate (CERO2),internal carotid arterial-venous oxygen content difference (Da-jvO2) and jugular venous oxygen saturation (SjvO2) were also detected.Results The scores of 12h-and 24h-Ramsay in the experimental group were (3.2±0.6) points,(2.5±0.6) points;and the control group were (3.9±0.7) points,(3.1±-0.6) points,respectively.The sedative effect of the experimental group was better than that of the control group at different time points (P＜0.05).Two groups of patients had simialr S-100,NSE,CERO2 protein and Da-jvO2 and SjvO2 levels before operation (P＞ 0.05).The levels of S-100,beta protein,NSE,CERO2 and SjvO 2 in the two groups were increased (P＜0.05) after 24h,but the experiment group had lower S-100,NSE,CERO2 protein,Da-jvO2 levels and higher SjvO2 level than the control group (P＜0.05).Conclusion Dexmedetomidine can improve the sedative effect and improve the cerebral oxygen metabolism in patients with severe traumatic brain injury,all of which have a certain protective effect on brain.