CAJ | 학술논문

目的：探讨盐酸右美托咪定在重型颅脑损伤应用中的安全性及其神经保护作用。方法选取72例重型颅脑损伤患者，随机分为对照组与观察组（各36例），均行有创颅内压探头植入，监测颅内压情况，对照组给予安慰剂加约束带固定，观察组给予右美托咪定1ug/kg，首剂于10min内静脉推注完毕后给予静脉泵按0.2~0.7ug/(kg.h）的输注速度持续静脉注射，以将患者镇静至Ramsay评分2~4分的用量为维持剂量，于用药后1h、6h、12h、24h、48h检查血气分析，记录动脉血氧分压及呼吸频率、心率、平均动脉压和颅内压，并对两组间上述指标进行对比分析。结果 PO2在1h、6h相比两组无明显差异，在第12h、24 h、48h观察组PO2较对照组明显升高（P＜0.05），两组呼吸频率在1h相比无明显差异，在第6h、12h、24 h、48h观察组较对照组明显下降（P<0.05）。两组心率在第1h、6h、12h、24h、48h均无明显差异（P>0.05），观察组与对照组比较平均动脉压在第1h、6h无明显差别，在第12h、24h、48h观察组平均动脉压明显降低，且具有统计学意义（P<0.05），两组颅内压情况在第1h、6h、12h、24h、48h均无明显差异（P>0.05）。结论右美托咪定镇静效果满意，可使患者随时保持可唤醒状态，且无呼吸抑制，安全性高，可降低脑代谢，减少脑耗氧量及脑灌注，适用于重型颅脑损伤患者镇静治疗。
목적：탐토염산우미탁미정재중형로뇌손상응용중적안전성급기신경보호작용。방법선취72례중형로뇌손상환자，수궤분위대조조여관찰조（각36례），균행유창로내압탐두식입，감측로내압정황，대조조급여안위제가약속대고정，관찰조급여우미탁미정1ug/kg，수제우10min내정맥추주완필후급여정맥빙안0.2~0.7ug/(kg.h）적수주속도지속정맥주사，이장환자진정지Ramsay평분2~4분적용량위유지제량，우용약후1h、6h、12h、24h、48h검사혈기분석，기록동맥혈양분압급호흡빈솔、심솔、평균동맥압화로내압，병대량조간상술지표진행대비분석。결과 PO2재1h、6h상비량조무명현차이，재제12h、24 h、48h관찰조PO2교대조조명현승고（P＜0.05），량조호흡빈솔재1h상비무명현차이，재제6h、12h、24 h、48h관찰조교대조조명현하강（P<0.05）。량조심솔재제1h、6h、12h、24h、48h균무명현차이（P>0.05），관찰조여대조조비교평균동맥압재제1h、6h무명현차별，재제12h、24h、48h관찰조평균동맥압명현강저，차구유통계학의의（P<0.05），량조로내압정황재제1h、6h、12h、24h、48h균무명현차이（P>0.05）。결론우미탁미정진정효과만의，가사환자수시보지가환성상태，차무호흡억제，안전성고，가강저뇌대사，감소뇌모양량급뇌관주，괄용우중형로뇌손상환자진정치료。
Objective To explore the safety and neuroprotective effect of the application of dexmedetomindine in severe brain inju-ry. Methods 72 cases with severe brain injury were randomly divided into 2 groups:control group and observation group, 36 in each;all the cases in both groups had invasive probe implantation for monitoring intracranial pressure;placebo plus fixation with restraint strap was given to cases in control group;for cases in observation group, dexmedetomidine (1ug/kg) was applied, the first dosage was intrave-nously injected over within 10 minutes and then at the speed of 0.2~0.7ug/(kg.h), dexmedetomidine was kept injecting by intravenous pump with the maintenance dosage which made the cases sedated with Ramsay scores of 2 to 4;at the time point of the1st hour, the 6th hour, the 12th hour, the 24th hour and the 48th hour after drug giving, blood gas analysis of cases in both groups was made and arterial par-tial pressure of oxygen, respiratory rate, heart rate, average arterial pressure and intracranial pressure were recorded;a comparative study was made between the 2 groups. Results There existed no difference of PO2 between the 2 groups at the time point of the 1st hour and the 6th hour after drug giving while PO2 in observation group increased much higher than that in control group at the time point of the 12th hour, the 24th hour and the 48th hour (P<0.05);the respiratory rates of the 2 groups were of no difference at the time point of the 1st hour while the rate in observation group dropped down much more than that in control group at the time point of the 6th hour, the 12th hour, the 24th hour and the 48h hour (P<0.05);the heart rates of the cases in the 2 group were of no difference at each time point (P<0.05);the aver-age arterial pressure in observation group was of no obvious difference from that in control group at the time point of the 1st hour and the 6th hour while it was much lower than that in control group at the time point of the 12th hour, the 24th hour and the 48h hour, the difference between the 2 groups was of statistical significance (P<0.05);there existed no difference of intracranial pressure in cases between the 2 groups at each time point (P<0.05).Conclusions Dexmedetomidine is of satisfactory sedative effect, making the patients be awaked easi-ly when necessary, it is suitable for sedation in patients with severe brain injury as it is of high safety with no respiratory depression, and can reduce the cerebral metabolism, decrease the cerebral oxygen consumption and cerebral perfusion.