摘要
目的探讨右美托咪定联合限制性液体复苏在重症颅脑损伤(STBI)患者院前急救中的应用效果。方法回顾性分析93例STBI患者的临床资料,根据院前急救的方式将患者分为对照组、观察组与联合组,每组31例。对照组患者采用积极液体复苏治疗,观察组患者采用限制性液体复苏治疗,联合组患者采用右美托咪定联合限制性液体复苏治疗。比较急救前、入院即刻3组患者生命体征指标[心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO_(2))]水平变化,以及入院即刻的凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体]、血清氧化应激指标[丙二醛、晚期氧化蛋白产物(AOPP)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)]、脑脊液神经活动指标[硫化氢、多巴胺、5-羟色胺、乙酰胆碱]、肾功能指标[血清肌酐、尿素氮、β_(2)-微球蛋白(β_(2)-MG)]水平及Glasgow昏迷量表(GCS)评分。术后6个月随访时,采用Glasgow预后量表(GOS)评估患者的预后情况,并分析联合组患者GOS分级与院前时间、右美托咪定使用剂量的相关性。结果入院即刻,3组患者的心率均低于急救前,MAP、SpO_(2)均高于急救前,且联合组与观察组的心率均低于对照组,MAP、SpO_(2)均高于对照组(均P<0.05);联合组与观察组的PT、APTT、D-二聚体水平均短于或低于对照组,FIB水平均高于对照组(均P<0.05);联合组和观察组以上指标差异均无统计学意义(均P>0.05)。联合组脑脊液硫化氢水平及血清肌酐、尿素氮、β_(2)-MG水平均低于观察组与对照组,而脑脊液多巴胺、5-羟色胺、乙酰胆碱水平及GCS评分均高于观察组与对照组(均P<0.05)。3组患者血清丙二醛、AOPP水平由低到高均为联合组、观察组、对照组,血清SOD、GSH-Px水平由高到低均为联合组、观察组、对照组(均P<0.05)。术后随访6个月时,联合组与观察组GOS分级�
Objective To investigate the application effect of dexmedetomidine combined with limited fluid resuscitation in pre-hospital care for patients with severe traumatic brain injury(STBI).Methods The clinical data of 93 patients with STBI were retrospectively analyzed.According to the approach in pre-hospital care,the patients were divided into control group,observation group and combination group,with 31 cases in each group.Patients in the control group were treated with positive fluid resuscitation,patients in the observation group were treated with limited fluid resuscitation,and patients in the combination group were treated with dexmedetomidine combined with limited fluid resuscitation.Multiple indices of the patients were compared among the three groups,including changes in the levels of vital signs indices(the heart rate,mean arterial pressure[MAP],pulse oxygen saturation[SpO_(2)])before first aid and at admission,as well as the levels of coagulation function indicators(prothrombin time[PT],activated partial thromboplastin time[APTT],fibrinogen[FIB],D-dimer),serum oxidative stress indices(malondialdehyde,advanced oxidation protein product[AOPP],superoxide dismutase[SOD],glutathione peroxidase[GSH-Px]),cerebrospinal fluid neurological activity indicators(hydrogen sulfide,dopamine,5-hydroxytryptamine[5-HT],acetylcholine)and renal function indicators(serum creatinine,urea nitrogen,β_(2)-microglobulin[β_(2)-MG]),and the Glasgow Coma Scale(GCS)score at admission.At the follow-up six months after the operation,the Glasgow Outcome Scale(GOS)was used to assess the prognosis of the patients,and the correlations of patient′s GOS rating with the pre-hospital time and the dosage of dexmedetomidine used in the combination group were analyzed.Results At admission,the heart rate was lower and the MAP and SpO_(2)were higher in the three groups as compared with those before the first aid,and the combination and observation groups exhibited lower heart rates and higher MAP and SpO_(2)than the control group(all P<0.05);PT an
作者
苑广超
张维义
王俊婷
王芳
夏维
YUAN Guang-chao;ZHANG Wei-yi;WANG Jun-ting;WANG Fang;XIA Wei(Department of Anesthesiology,Wuhan Hospital of Traditional Chinese Medicine,Wuhan 430014,China;Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430000,China)
出处
《广西医学》
CAS
2022年第6期596-601,605,共7页
Guangxi Medical Journal
基金
湖北省卫生健康委员会科研项目(wj2017m083)。
关键词
重症颅脑损伤
右美托咪定
限制性液体复苏
院前急救
氧化应激
肾功能
神经功能
凝血功能
预后
Severe traumatic brain injury
Dexmedetomidine
Limited fluid resuscitation
Pre-hospital care
Oxidative stress
Renal function
Nerve function
Coagulation function
Prognosis
