CAJ | 학술논문

目的：探讨丙泊酚持续静脉输注治疗外伤性颅脑损伤患者手术后脑水肿的临床疗效。方法将2012年1月至2013年12月急诊入院的外伤性颅脑损伤患者68例随机分为对照组与观察组，每组各34例。两组患者均行急诊开颅手术治疗后，对照组给予术后常规脱水降低颅内压、止血、抗感染、营养神经及其他对症支持治疗；观察组在对照组治疗用药的基础上，于手术后第1天即开始接受丙泊酚持续静脉输注治疗。先给予丙泊酚1.5 mg·kg-1静推作为镇静诱导，再对患者进行持续静脉输注0.3~0.4 mg·kg-1·h-1，用药时间至少持续到手术后第3天。使用CT检查术后患者脑水肿的动态变化情况，并监测患者颅内压（ ICP）变化，术后6个月随访，使用MMSE评分量表对两组患者进行评分。结果观察组患者手术后第3~4天及第7~8天脑水肿量较对照组有明显减少（ P <0.01）；术后第1天、第4天、第7天、第10天观察组ICP均显著低于对照组（ P <0.01）；术后6个月观察组患者MMSE评分较对照组有所增高，但差异无统计学意义（ P >0.05）。结论丙泊酚静脉持续输注可有效减轻外伤性颅脑损伤患者手术后脑水肿的程度，降低颅内压，从而提高外伤性颅脑损伤手术的疗效。
목적：탐토병박분지속정맥수주치료외상성로뇌손상환자수술후뇌수종적림상료효。방법장2012년1월지2013년12월급진입원적외상성로뇌손상환자68례수궤분위대조조여관찰조，매조각34례。량조환자균행급진개로수술치료후，대조조급여술후상규탈수강저로내압、지혈、항감염、영양신경급기타대증지지치료；관찰조재대조조치료용약적기출상，우수술후제1천즉개시접수병박분지속정맥수주치료。선급여병박분1.5 mg·kg-1정추작위진정유도，재대환자진행지속정맥수주0.3~0.4 mg·kg-1·h-1，용약시간지소지속도수술후제3천。사용CT검사술후환자뇌수종적동태변화정황，병감측환자로내압（ ICP）변화，술후6개월수방，사용MMSE평분량표대량조환자진행평분。결과관찰조환자수술후제3~4천급제7~8천뇌수종량교대조조유명현감소（ P <0.01）；술후제1천、제4천、제7천、제10천관찰조ICP균현저저우대조조（ P <0.01）；술후6개월관찰조환자MMSE평분교대조조유소증고，단차이무통계학의의（ P >0.05）。결론병박분정맥지속수주가유효감경외상성로뇌손상환자수술후뇌수종적정도，강저로내압，종이제고외상성로뇌손상수술적료효。
Objective To explore the clinical efficacy of propofol continuous intravenous therapy on cerebral edema after surgery on trau-matic craniocerebral injury. Methods A total of 68 patients with traumatic craniocerebral injury in this hospital during January 2012 to December 2013 were collected and randomly divided into observation group and control group,34 patients in each group. Patients in both groups received e-mergency operation for treatment. After operation,patients in control group were treated with conventional dehydration in order to reduce the in-tracranial pressure( ICP),stopping bleeding,anti-infection,nutritional supply and other support therapy;patients in observation group received propofol continuous intravenous therapy on the first day after surgery on the basis of treatment in control group. Propofol 1. 5 mg·kg-1 intravenous injection was used for calm inducement,and then,propofol 0. 3~0. 4 mg·kg-1 ·h-1 continuous venous infusion was continued for at least 3 days after operation. The postoperative dynamic changes of cerebral edema in patients were examined by CT scanning,and changes in ICP were al-so monitored. MMSE scores were estimated and recorded in follow-up period for six months after surgery. Results Volume of cerebral edema in 3 to 4 days and 7 to 8 days after operation in patients of observation group had been significantly reduced compared with that of patients in control group( P <0. 01). At 1 day,4 days,7 days and 10 days after surgery,ICP of patients in observation group was significantly lower than that of control group( P <0. 01). The difference in MMSE scores between two groups was not significant in follow-up period for six months after surgery ( P >0. 05),although it was higher in observation group than that of control group. Conclusion Propofol continuous intravenous therapy can re-duce the degree of cerebral edema and ICP after operation for traumatic craniocerebral injury,and thereby it can improve the clinical effect of oper-ation for traumatic craniocerebral injury.