CAJ | 학술논문

目的探索右美托咪啶在颅脑创伤镇痛镇静治疗中的治疗方案,观察其安全性,并讨论镇痛镇静治疗对颅脑创伤的意义.方法为前瞻性临床研究,选择了中度颅脑创伤患者28例,GCS 13～7分,排除低血压、休克及高血压等情况；采用右美托咪啶负荷量0.5～1 μg/kg,30 min注射,0.3 ～0.5 μg/ (kg·h)维持,同时监测血压、呼吸、动脉血气等变化,以镇静评分(SAS)和镇痛评分( VRS、FPS)达标为方向,结合生理(心率、血压)及躯体反应(焦虑、躁动)进行综合评估.结果症状及体征减轻或消除的有效率为85.71％,加用吗啡后可达92.85％,上述负荷及维持量下血压、心率下降幅度为14％～20％,部分患者可达25％以上,呼吸功能无明显抑制；未发现其他不良反应.结论右美托咪啶在中度颅脑伤患者中使用,疗效肯定,具有一定程度血压下降和心率减慢,但在本治疗剂量内具有安全性.
목적 탐색우미탁미정재로뇌창상진통진정치료중적치료방안,관찰기안전성,병토론진통진정치료대로뇌창상적의의.방법 위전첨성림상연구,선택료중도로뇌창상환자28례,GCS 13～7분,배제저혈압、휴극급고혈압등정황；채용우미탁미정부하량0.5～1 μg/kg,30 min주사,0.3 ～0.5 μg/ (kg·h)유지,동시감측혈압、호흡、동맥혈기등변화,이진정평분(SAS)화진통평분( VRS、FPS)체표위방향,결합생리(심솔、혈압)급구체반응(초필、조동)진행종합평고.결과 증상급체정감경혹소제적유효솔위85.71％,가용마배후가체92.85％,상술부하급유지량하혈압、심솔하강폭도위14％～20％,부분환자가체25％이상,호흡공능무명현억제；미발현기타불량반응.결론 우미탁미정재중도로뇌상환자중사용,료효긍정,구유일정정도혈압하강화심솔감만,단재본치료제량내구유안전성.
Objective To explore the role and safety of right dexmedetomidine in the analgesic and sedative treatment for brain injury patients and evaluate the significance of analgesic and sedative treatment for brain injury patients.Methods This prospective clinical study induced 28 patients with moderate brain trauma scored with GCS 7 ～ 13 points without hypotension,shock and hypertension.The patients were treated with right dexmedetomidine in loading dose of 0.5 ～ 1.0 μg/kg and maintenance dose given by continuous infusion in rate of 0.3 ～ 0.5 μg/ ( kg · h) for 30 minutes.Blood pressure,heart rate,respiration,arterial blood gas,selected sedation score ( self - rating anxiety scale:SAS) and analgesic score (verbal rating scale:VRS,faces pain scale:FPS),psychic symptoms (anxiety,agitation) were monitored and documented for the comprehensive assessment of the efficacy of this treatment whether that reached up to the scratch of ideal sedation and analgesia.Results The sedative and analgesic efficacy of this treatment was found in 85.71％ of patients,and it was up to 92.85％ after morphine added.Blood pressure and heart rate decreased by 14 -20％ after treatment,and only a few patients had them dropped down by 25％ under the loading and maintaining doses.There was no significant inhibition of respiration,and other adverse reactions were not found.Conclusions Right dexmedetomidine was effective in patients with moderate brain injury.It caused certain degree of decrease in blood pressure and heart rate,but it was safe within the therapeutic dose.