摘要
目的探究右美托咪定联合限制性液体复苏救治对重症颅脑损伤(severe traumatic brain injury,STBI)患者血流动力学、脑氧代谢及预后的影响。方法研究选取2020年4月至2022年12月救治的96例STBI患者,按随机数字表法分为治疗组和对照组各48例,对照组术前进行限制性液体复苏,治疗组在对照组基础上联合右美托咪定治疗。比较两组患者复苏前后血流动力学[心率、平均动脉压(MAP)、血氧饱和度(SpO_(2))]脑氧代谢[颈内静脉氧饱和度(SjVO_(2))、脑动静脉血氧含量差(AV-DO_(2))、脑氧摄取率(CERO_(2))]、炎症因子[C反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]及神经损伤因子[神经元特异性烯醇化酶(NSE)、s-100β蛋白]水平;术后随访3个月,采用格拉斯哥预后评分(GOS)评估患者短期预后。结果复苏后,两组患者心率均较复苏前下降,MAP、SpO_(2)均较复苏前升高(P<0.05),且治疗组心率低于对照组(P<0.05);两组患者SjVO_(2)均较复苏前升高,AV-DO_(2)、CERO_(2)均下降(P<0.05),且治疗组SjVO_(2)较对照组高,CERO_(2)较对照组低(P<0.05);两组患者血清CRP、IL-6、TNF-α水平均较复苏前升高(P<0.05),但治疗组血清CRP、IL-6、TNF-α水平较对照组低(P<0.05);两组患者血清NSE、s-100β水平均较复苏前升高(P<0.05),但治疗组血清NSE、s-100β水平较对照组低(P<0.05)。术后3个月随访时,两组患者GOS预后分级比较差异有统计学意义(P<0.05),且治疗组预后良好率68.75%,优于对照组的45.83%(P<0.05)。结论右美托咪定联合限制性液体复苏用于STBI患者救治,可有效改善患者血流动力学、脑氧代谢,还能减轻炎症反应、抑制脑损伤,对改善患者短期预后有积极意义。
Objective To explore the effects of dexmedetomidine combined with limited fluid resuscitation treatment on hemodynamics,cerebral oxygen metabolism and prognosis in patients with severe traumatic brain injury(STBI).Methods Totally 96 patients with STBI who were treated from April 2020 to December 2022 were selected and divided into treatment group and control group by the random number table method,with 48 cases in each group.The control group received limited fluid resuscitation before surgery,and the treatment group was given dexmedetomidine on the ba⁃sis of the control group.The hemodynamics[heart rate,mean arterial pressure(MAP),oxygen saturation(SpO_(2))],cerebral oxygen metabolism[internal jugular venous oxygen saturation(SjVO_(2)),arteriovenous oxygen difference(AV-DO_(2)),cerebral oxygen extraction rate(CERO_(2))],inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)]and nerve injury factors[neuron-specific enolase(NSE),s-100βprotein]were compared between the two groups before and after resuscitation.Glasgow Outcome Score(GOS)was used to evaluate the short-term prognosis of patients at 3-month follow-up after surgery.Results After resuscitation,the heart rate in both groups was decreased compared with that before resuscitation while the MAP and SpO_(2)were increased compared with those before resuscitation(P<0.05),and the heart rate in treatment group was lower than that in control group(P<0.05).SjVO_(2)in the two groups was enhanced while the AV-DO_(2)and CERO_(2)were reduced compared to before resuscitation(P<0.05).SjVO_(2)in treatment group was higher while the CERO_(2)was lower than that in control group(P<0.05).Serum levels of CRP,IL-6 and TNF-αin both groups were risen compared with those before re⁃suscitation(P<0.05),but the levels were lower in treatment group than those in control group(P<0.05).Serum NSE and s-100βlevels in the two groups were elevated compared to before resuscitation(P<0.05),but serum NSE and s-100βlevels in treatment group were
作者
李克
刘大东
LI Ke;LIU Da-dong(EICU Emergency Department,Pingmei Shenma Medical Group General Hospital,Pingdingshan,Henan 467000,China)
出处
《医药论坛杂志》
2023年第20期86-91,共6页
Journal of Medical Forum
关键词
重症颅脑损伤
液体复苏
右美托咪定
血流动力学
脑氧代谢
Severe traumatic brain injury
Fluid resuscitation
Dexmedetomidine
Hemodynamics
Cerebral oxygen me⁃tabolism
