镇痛镇静对重症蛛网膜下腔出血患者脑代谢的影响

目的观察镇痛镇静对重症蛛网膜下腔出血患者脑代谢的影响。方法对34例重症蛛网膜下腔出血患者采用自身对照研究方法，人院后进行常规止血、脱水降颅压、抗血管痉挛治疗，依据患者疼痛和烦躁程度进行镇痛镇静治疗，选择丙泊酚、咪达唑仑和芬太尼的组合。比较镇痛镇静前、镇静镇痛过程中、镇静镇痛结束后1h,3h及6h颈动脉血氧饱和度、颈静脉血氧饱和度以及中心静脉血氧饱和度。结果患者镇静镇痛前后颈动脉血氧饱和度无明显改变；颈静脉血氧饱和度和中心静脉血氧饱和度在镇静镇痛前偏低，镇静镇痛后2h恢复正常，在镇静镇痛结束后1h．3h及6h逐渐下降，接近于镇静镇痛前水平。结论镇痛镇静在降低全身代谢的同时可以降低脑氧代谢。

Effect of analgesia and sedation on cerebral metabolism in the patients with severe subarachnoid hemorrhage

Objective To observe the effect of sedation and analgesia on cerebral metabolism in patients with severe subarachnoid hemorrhage. Methods Thirty-four patients with severe subarachnoid hemorrhage was cho- sen, and the way of self-control study was used. Conventional hemostasis, dehydration and anti-vasospasm therapies were employed after admission. According to the level of pain and irritable of patients, fentanyl was associated with propofol and midazolam respectively for therapy. The carotid venous oxygen saturation were detected before treatment, during treatment,and at 1 hour,3 hours and 6 hours after the end of treatment. Results There was no significant change in carotid arterial oxygen saturation before and after treatment. After treatment ,jugular venous oxygen satura- tion and central venous oxygen saturation were lower than those before treatment, returned to normal at 2 hours after treatment and gradually decreased to close to the level before treatment at 1 hour,3 hours and 6 hours after the end of treatment. Conclusion Analgesia and sedation could reduce cerebral oxygen metabolism at the same time reducing the systemic metabolism.