镇痛镇静对重型脑损伤患者心率变异性及血清儿茶酚胺变化的影响

发布时间：2018-06-13 08:59

本文选题：脑损伤 + 镇痛　；参考：《福建医科大学学报》2016年01期

【摘要】：目的研究镇痛镇静对重型脑损伤患者早期心率变异性(HRV)及血清儿茶酚胺的影响,明确重型脑损伤患者早期使用镇痛镇静剂的安全性及有效性。方法单中心、前瞻性、非随机对照、开放研究。收集起病48h内入住外科重症病房(SICU)的重型脑损伤患者34例为研究对象,其中镇静组15例在入住SICU后即予咪达唑仑及舒芬太尼持续镇痛镇静,非镇静组19例按SICU常规治疗。连续3d监测所有患者同一时间段24h动态心电图;连续4d检测所有患者每天8:00血儿茶酚胺(肾上腺素、去甲肾上腺素)水平。收集同期24例体检者作为对照组。结果镇静组及非镇静组的血清儿茶酚胺的水平与正常参考值比较均升高(P0.05),非镇静组儿茶酚胺水平较镇静组高,但差别无统计学意义(P0.05)。镇静组和非镇静组的HRV各指标水平均明显小于对照组(P0.05)。短期预后评估中镇静组的昏迷天数、总住院时间均明显小于非镇静组(P0.05)。结论重型脑损伤可引起血清儿茶酚胺升高及自主神经功能紊乱。镇痛镇静可以改善自主神经功能紊乱,减少儿茶酚胺分泌,改善短期预后,但仍需大样本的研究以证实。
[Abstract]:Objective to study the effects of analgesia and sedation on heart rate variability (HRV) and serum catecholamine in patients with severe brain injury, and to determine the safety and efficacy of early use of analgesic sedatives in patients with severe brain injury. Methods single center, prospective, non-randomized controlled open trial. Thirty-four patients with severe brain injury admitted to surgical intensive care unit (SICU) within 48 hours were selected as study subjects. 15 patients in sedation group were treated with midazolam and sufentanil after admission to SICU, 19 patients in non-sedative group were treated with routine therapy in SICU. The serum catecholamine (epinephrine, norepinephrine) levels were measured at 8:00 for 4 consecutive days. 24 cases of physical examination in the same period were collected as control group. Results the levels of serum catecholamine in sedation group and non-sedative group were higher than those in normal control group (P 0.05). The level of catecholamine in non-sedative group was higher than that in sedative group, but the difference was not statistically significant (P 0.05). The levels of HRV in sedation group and non-sedative group were significantly lower than those in control group (P 0.05). The duration of coma in sedation group was significantly shorter than that in non-sedative group (P 0.05). Conclusion severe brain injury can cause serum catecholamine elevation and autonomic nervous dysfunction. Analgesia and sedation can improve autonomic nervous dysfunction, reduce catecholamine secretion and improve short-term prognosis.
【作者单位】：福建省立医院重症医学三科;福建医科大学省立临床医学院;福建医科大学附属龙岩市第一医院麻醉科;
【基金】：国家重点专科建设项目[财社2011(170)] 福建省卫生厅创新基金(2009-CXB-1)
【分类号】：R651.15

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