中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2013年
6期
373-376
,共4页
郝江%罗积慎%翁奇%何毅%刘军%杨明浩%边革元%刘涛
郝江%囉積慎%翁奇%何毅%劉軍%楊明浩%邊革元%劉濤
학강%라적신%옹기%하의%류군%양명호%변혁원%류도
颅脑创伤%镇痛镇静%右美托咪定%β-内啡肽
顱腦創傷%鎮痛鎮靜%右美託咪定%β-內啡肽
로뇌창상%진통진정%우미탁미정%β-내배태
Brain injury%Analgesic-sedative treatment%Dexmedetomidine%β-endorphin
目的 对比右美托咪定(DEX)与异丙酚在早期中、重度颅脑创伤(TBI)患者镇痛镇静中的疗效及β-内啡肽(β-EP)的影响.方法 选择格拉斯哥昏迷评分(GCS)6～13分的中、重度TBI患者90例,按入院顺序的单双号随机分为3组.A组(DEX/+吗啡)DEX负荷量为0.5 ～ 1.0 μg/kg,30 min注完,0.2 ～ 0.6 μg·kg-1·h-1维持24 h;B组(异丙酚/+吗啡)异丙酚负荷剂量为0.5～2.0 mg/kg,10 min注完,1～3 mg·kg-1·h-1维持72 h；以上两组疗效不佳者加用吗啡静脉注射.C组采用哌替啶等临时用药.以Riker镇静和躁动评分结合生理与躯体反应阳性指标消除对患者进行综合评估,监测生命体征,检测用药前后外周血白细胞计数(WBC)、血糖、皮质醇、β-EP水平.结果 ①A、B、C组镇静有效率分别为84.38％(27/32)、80.64％(25/31)、77.78％(21/27),A组吗啡追加剂量(mg)低于B组(24 h用量:16.23±3.45比21.34±5.55).②A组患者血压及心率改变明显,其中A组达负荷量0.5 h平均动脉压(MAP,mm Hg,1 mm Hg=0.133 kPa)即明显低于B组和C组(75.50±9.35比87.90±8.05、85.70±7.10,均P＜0.05).③A、B组用药后WBC与皮质醇呈下降趋势,其中A组WBC降幅大于B组,B组皮质醇降幅大于A组；C组24 h后才开始下降.④B组用药前后血糖与β-EP水平无明显改变,但A组和C组β-EP有增高趋势,C组增幅大于A组增幅.结论 DEX对中、重度TBI患者的镇静疗效优于异丙酚,并能更好地控制TBI后过度应激反应,血压影响较异丙酚明显,但减量或停药后多能快速恢复；DEX早期具有一定程度升高血浆β-EP的作用,考虑其在早期应激调控中有积极意义.
目的 對比右美託咪定(DEX)與異丙酚在早期中、重度顱腦創傷(TBI)患者鎮痛鎮靜中的療效及β-內啡肽(β-EP)的影響.方法 選擇格拉斯哥昏迷評分(GCS)6～13分的中、重度TBI患者90例,按入院順序的單雙號隨機分為3組.A組(DEX/+嗎啡)DEX負荷量為0.5 ～ 1.0 μg/kg,30 min註完,0.2 ～ 0.6 μg·kg-1·h-1維持24 h;B組(異丙酚/+嗎啡)異丙酚負荷劑量為0.5～2.0 mg/kg,10 min註完,1～3 mg·kg-1·h-1維持72 h；以上兩組療效不佳者加用嗎啡靜脈註射.C組採用哌替啶等臨時用藥.以Riker鎮靜和躁動評分結閤生理與軀體反應暘性指標消除對患者進行綜閤評估,鑑測生命體徵,檢測用藥前後外週血白細胞計數(WBC)、血糖、皮質醇、β-EP水平.結果 ①A、B、C組鎮靜有效率分彆為84.38％(27/32)、80.64％(25/31)、77.78％(21/27),A組嗎啡追加劑量(mg)低于B組(24 h用量:16.23±3.45比21.34±5.55).②A組患者血壓及心率改變明顯,其中A組達負荷量0.5 h平均動脈壓(MAP,mm Hg,1 mm Hg=0.133 kPa)即明顯低于B組和C組(75.50±9.35比87.90±8.05、85.70±7.10,均P＜0.05).③A、B組用藥後WBC與皮質醇呈下降趨勢,其中A組WBC降幅大于B組,B組皮質醇降幅大于A組；C組24 h後纔開始下降.④B組用藥前後血糖與β-EP水平無明顯改變,但A組和C組β-EP有增高趨勢,C組增幅大于A組增幅.結論 DEX對中、重度TBI患者的鎮靜療效優于異丙酚,併能更好地控製TBI後過度應激反應,血壓影響較異丙酚明顯,但減量或停藥後多能快速恢複；DEX早期具有一定程度升高血漿β-EP的作用,攷慮其在早期應激調控中有積極意義.
목적 대비우미탁미정(DEX)여이병분재조기중、중도로뇌창상(TBI)환자진통진정중적료효급β-내배태(β-EP)적영향.방법 선택격랍사가혼미평분(GCS)6～13분적중、중도TBI환자90례,안입원순서적단쌍호수궤분위3조.A조(DEX/+마배)DEX부하량위0.5 ～ 1.0 μg/kg,30 min주완,0.2 ～ 0.6 μg·kg-1·h-1유지24 h;B조(이병분/+마배)이병분부하제량위0.5～2.0 mg/kg,10 min주완,1～3 mg·kg-1·h-1유지72 h；이상량조료효불가자가용마배정맥주사.C조채용고체정등림시용약.이Riker진정화조동평분결합생리여구체반응양성지표소제대환자진행종합평고,감측생명체정,검측용약전후외주혈백세포계수(WBC)、혈당、피질순、β-EP수평.결과 ①A、B、C조진정유효솔분별위84.38％(27/32)、80.64％(25/31)、77.78％(21/27),A조마배추가제량(mg)저우B조(24 h용량:16.23±3.45비21.34±5.55).②A조환자혈압급심솔개변명현,기중A조체부하량0.5 h평균동맥압(MAP,mm Hg,1 mm Hg=0.133 kPa)즉명현저우B조화C조(75.50±9.35비87.90±8.05、85.70±7.10,균P＜0.05).③A、B조용약후WBC여피질순정하강추세,기중A조WBC강폭대우B조,B조피질순강폭대우A조；C조24 h후재개시하강.④B조용약전후혈당여β-EP수평무명현개변,단A조화C조β-EP유증고추세,C조증폭대우A조증폭.결론 DEX대중、중도TBI환자적진정료효우우이병분,병능경호지공제TBI후과도응격반응,혈압영향교이병분명현,단감량혹정약후다능쾌속회복；DEX조기구유일정정도승고혈장β-EP적작용,고필기재조기응격조공중유적겁의의.
Objective To compare the efficacy of dextraldexmede (DEX) and propofol on sedation and β-endorphin (β-EP) in patients with moderate and severe traumatic brain injury (TBI).Methods Ninety patients with moderate and severe TBI with Glasgow coma score (GCS) 6-13 were randomly divided into three groups according to the order of admission of odd and even numbers.In group A (DEX/+morphine),DEX load 0.5-1.0 μg/kg was injected within 30 minutes,and maintaining at 0.2-0.6 μg ·kg-1 ·h-1 for 24 hours; and in group B (propofol/+morphine),propofol load 0.5-2.0 mg/kg was injected within 10 minutes,and maintaining at 1-3 mg·kg-1 ·h-1 for 72 hours.Patients with poor efficacy were added with morphine intravenously.In group C,intramuscular injection of pethidine and other temporary medication was injected.The comprehensive assessment was conducted according to the Riker sedation and agitation score,combined with the physiological body reaction positive indicator elimination.The vital signs was monitored,and blood white blood cell (WBC) count,blood sugar,cortisol and β-EP before and after administration were determined.Results ①The sedation efficiency rate of the group A,B,C were 84.38％ (27/32),80.64％ (25/31),77.78％ (21/27),respectively.The booster dose of morphine (mg) in group A was less than that in group B (24 h dosage:16.23 ± 3.45 vs.21.34 ± 5.55).②Blood pressure and heart rate were significantly affected in the group A.The mean arterial pressure (MAP,mm Hg,1 mm Hg=0.133 kPa) in 0.5 hour of reaching loading dose in group A was significantly lower than that in group B and C (75.50 ± 9.35 vs.87.90 ± 8.05,85.70 ± 7.10,both P＜0.05).③ WBC and cortisol levels showed downwards trends after treatment in group A and group B ; WBC fell more in the group A compared with group B,cortisol level fell more in group B compared with group A,and the WBC and cortisol level began to decline after 24 hours in group C.④ There were no significant differences in blood sugar and β-EP levels before and after treatment in group B,but β-EP had an increasing tendency in group A and group C,and the amplification in group C was more obvious than that in group A.Conclusion The sedation efficacy of DEX was superior to propofol in moderate and severe TBI,and was able to control excessive stress response after TBI better,and with more effect on blood pressure.Plasma β-EP was elevated during the early phase of brain injury by DEX,which was considered as its positive role in the regulation of early stress.
