右美托咪定在创伤性脑损伤患者镇静治疗中的应用研究
发布时间：2018-07-15 11:57
【摘要】：目的:右美托咪定作为一种相对比较新的镇静药物,其在神经外科中的应用缺乏临床证据,本研究旨在研究探讨右美托咪定在创伤性脑损伤(TBI)患者镇痛镇静治疗中的作用疗效。方法:选取2014年1月至2015年12月天津市人民医院神经外科收治的120例创伤性脑损伤(TBI)患者为研究对象,按照随机数字表法随机分为右美托咪定组(n=60例)和冬眠合剂组(n=60例)(分组采用随机分配,并经统计软件分析后右美托咪定组和冬眠合剂组两组患者在年龄、男女性别比例、体重、GCS评分方面的比较差异无统计学意义,有可比性,右美托咪定组给予右美托咪定(2ml:200μg,江苏恒瑞医药股份有限公司)负荷剂量为0.5-1.0μg/kg,持续泵注10min,后以0.2-0.7μg·kg-1·h-1速度维持3天;冬眠合剂组肌注冬眠合剂(盐酸氯丙嗪注射液,2ml:50mg,上海禾丰制药有限公司;盐酸异丙嗪注射液,2ml:50mg,天津金耀药业有限公司;盐酸哌替啶注射液,2ml:100mg,宜昌人福药业有限责任公司),间隔8小时给药一次,维持3天。对右美托咪定组和冬眠合剂组两组患者年龄、性别比例、体重、GCS评分进行比较,记录右美托咪定组和冬眠合剂组两组患者用药前、用药后1h、用药后4h时心率、平均动脉压(MAP)、呼吸频率、血氧饱和度(SpO2)变化,24h血压波动幅度,以及用药前、用药后1天、用药后3天、用药后5天C-反应蛋白含量的变化,对比用药后7天内右美托咪定组(浅镇静组及深镇静组)与冬眠合剂组不良反应及并发症(心动过缓、低血压、应激性溃疡、肺部感染等)发生情况、ICU住院天数及总住院天数,以及随访患者6个月后患者的预后情况(格拉斯哥预后评分GOS)等因素进行统计学分析。结果:1.右美托咪定组患者年龄(36.2±10.8岁)、性别(男女比例38/22)、体重(68.3±13.2kg)、GCS评分(10.8±3.2分),与冬眠合剂组年龄(34.6±11.2岁)、性别(男女比例43/17)、体重(65.5±11.5kg)、GCS评分(10.2±2.6分)等比较差异无统计学意义(P0.05)。2.用药后心率及血压比较,用药后1h右美托咪定组,心率72.4±7.8次/分,血压87.8±8.1mmHg,相较于用药前无较大变化,但冬眠合剂组心率66.2±7.6次/分,血压87.8±8.1 mmHg明显降低。而用药后右美托咪定组和冬眠合剂组两组患者血氧饱和度(右美托咪定组96.4±2.9,冬眠合剂组96.2±2.1)均无明显变化。3.右美托咪定组和冬眠合剂组两组患者C-反应蛋白入院后均持续升高,第3天达峰值,右美托咪定组为32.8±7.1mg/L,冬眠合剂组为41.2±7.9mg/L,但右美托咪定组用药1天后C-反应蛋白增幅较冬眠合剂组明显降低,用药后右美托咪定组和冬眠合剂组的C-反应蛋白含量分别为28.5±6.2mg/L、34.8±7.2mg/L。4.心动过缓、低血压、应激性溃疡、肺部感染发生率比较,右美托咪定组发生人次分别为13、10、7、8,冬眠合剂组则为23、20、16、17,右美托咪定组显著低于冬眠合剂组,而在右美托咪定组组内比较时,浅镇静组(心动过缓3人次、低血压2人次、应激性溃疡1人、肺部感染1人)明显低于深镇静组(心动过缓10人次、低血压8人次、应激性溃疡6人、肺部感染7人)。5.右美托咪定组患者的ICU住院时间(12.8±5.5日)及总住院时间(21.2±6.5日)相较于冬眠合剂组的ICU住院时间(15.3±6.1日)及总住院时间(28.5±7.4日)均显著缩短。6.伤后6个月随访,右美托咪定组和冬眠合剂组两组预后,格拉斯哥预后评分GOS1-5分的人数比较,右美托咪定组分别为3、5、10、15、27人,而冬眠合剂组则分别为5、9、13、16、17人,组间比较采用Ridit分析(R值右美托咪定=0.552,R值冬眠合剂=0.448,P=0.048),右美托咪定组好于冬眠合剂组。但右美托咪定组与冬眠合剂组的病死率无显著差别(5%vs.8.3%)。结论:1.创伤性脑损伤(TBI)患者应用右美托咪定镇静治疗效果满意,作用显著,可使患者随时保持可唤醒状态,且对呼吸及循环系统无明显影响。2.右美托咪定可以明显降低C-反应蛋白水平,抑制炎性反应,缩短住院时间,改善患者的预后,适用于神经外科颅脑外伤躁动患者的镇静治疗。3.应用右美托咪定镇静时,浅镇静能减少不良反应及并发症的发生,在临床工作中应注意监测镇静深度,维持较浅的镇静状态。
[Abstract]:Objective: dexmedetomidine, as a relatively new sedative drug, lacks clinical evidence in the Department of neurosurgery. The purpose of this study was to investigate the effect of dexmedetomidine on analgesic and sedative treatment in patients with traumatic brain injury (TBI). Methods: selected from January 2014 to December 2015 in Tianjin People's Hospital. 120 patients with traumatic brain injury (TBI) were randomly divided into right metoimidin group (n=60) and hibernation mixture group (n=60 cases), and two groups of patients in the right metoimidine group and hibernation mixture group were in age, sex ratio, weight, and GCS score after the statistical software analysis. There was no statistical difference. There was a comparability. The load dose of right metomomidin group (2ml:200 mu g, Jiangsu Heng Rui Limited by Share Ltd) was 0.5-1.0 u g/kg, 10min was continuously pumped, and then 0.2-0.7 mu g. Kg-1. H-1 was maintained for 3 days; the hibernating group was injected with hibernation mixture (Chlorpromazine Hydrochloride Injection, 2ml:50mg,). Shanghai Hefeng Pharmaceutical Co., Ltd., Promethazine Hydrochloride Injection, 2ml:50mg, Tianjin Jin Yao Pharmaceutical Co., Pethidine Hydrochloride Injection, 2ml:100mg, Yichang fufu Pharmaceutical Co., Ltd., were administered once, for 3 days at intervals of 8 hours. The age, sex ratio, weight, and GCS score of the right metoimidin group and the hibernation mixture group were carried out. Comparison, records of two groups of patients with right metoimidin group and hibernation mixture group, heart rate, mean arterial pressure (MAP), respiratory frequency, oxygen saturation (SpO2), 24h blood pressure fluctuation, 1 days after medication, 3 days after medication, 3 days after medication, 5 days after medication, 5 days after medication, and within 7 days after medication. The adverse reactions and complications (bradycardia, hypotension, stress ulcers, lung infection, etc.) in the dexmedetomidine group (shallow sedation group and deep sedation group) and hibernation mixture group, the number of ICU days and total hospitalization days, and the prognosis of the patients after 6 months of follow-up (the Glasgow prognosis score GOS) were counted. Results: 1. the age (36.2 + 10.8 years), sex (male and female ratio 38/22), weight (68.3 + 13.2kg), GCS score (10.8 + 3.2), age (34.6 + 11.2 years), sex (43/17), weight (65.5 + 11.5kg), and GCS score (10.2 + 2.6)) were not statistically significant (P0.05) heart rate after.2.. Compared with the blood pressure, the heart rate of 1H right metomomimidin group was 72.4 + 7.8 / min and the blood pressure was 87.8 + 8.1mmHg, compared with before the medication, but the heart rate of the hibernation mixture group was 66.2 + 7.6 / min, and the blood pressure was 87.8 + 8.1 mmHg, and the blood oxygen saturation was 96.4 + 2. in right metoimidin group and hibernation mixture group (96.4 + 2.) after drug use. 9, the hibernation mixture group 96.2 + 2.1) had no obvious changes in.3. right metomomidin group and hibernation mixture group two patients after admission to the hospital continued to increase, third Tianda peak, right metoimidin group was 32.8 7.1mg/L, the hibernation mixture group was 41.2 + 7.9mg/L, but the right metoimidin group used 1 days after the C- reaction protein increase than the hibernating mixture group was obvious. The C- reaction protein content in right metoimidin group and hibernation mixture group was 28.5 + 6.2mg/L, 34.8 + 7.2mg/L.4. bradycardia, hypotension, stress ulcer, lung infection rate compared, right metoimidin group was 13,10,7,8, hibernating group was 23,20,16,17, right metoimidin group was significantly lower than hibernation In the mixture group, while in the right metoimidin group, the shallow sedation group (3 bradycardia, 2 hypotension, 1 stress ulcer, 1 lung infection) was significantly lower than the deep sedation group (10 times of bradycardia, 8 hypotension, 6 stress ulcers and 7 lung infection) in the.5. right metoimidin group (12.8 + 5.5 days). The total hospitalization time (21.2 + 6.5 days) compared with the ICU hospitalization time of the hibernation mixture group (15.3 + 6.1 days) and the total hospitalization time (28.5 + 7.4 days) significantly shortened the follow-up for 6 months after.6. injury. The prognosis of the right metoimidin group and the hibernation mixture group was two, the number of GOS1-5 scores in the prognosis score of Glasgow was compared, and the right metoimidin group was 3,5,10,15,27, respectively. The hibernation mixture group was 5,9,13,16,17, and the group was compared with Ridit analysis (R value dexmedetomidin =0.552, R value hibernation mixture =0.448, P=0.048), right metoimidin group was better than hibernation mixture group, but there was no significant difference between right metoimidin group and hibernation mixture group (5% vs.8.3%). Conclusion: 1. patients with traumatic brain injury (TBI) use right beauty. The effect of TMD is satisfactory, and the effect is remarkable. It can keep the patients awake at any time, and have no obvious influence on the respiratory and circulatory system..2. right metoomidin can obviously reduce the level of C- reaction protein, inhibit the inflammatory reaction, shorten the time of hospitalization and improve the patient's precondition, which is suitable for the town of brain trauma restless patients in Department of neurosurgery. In the treatment of.3. with dexmedetomidin, shallow sedation can reduce the incidence of adverse reactions and complications. In clinical work, we should monitor the depth of sedation and maintain a relatively shallow sedation.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
本文编号：2123996
[Abstract]:Objective: dexmedetomidine, as a relatively new sedative drug, lacks clinical evidence in the Department of neurosurgery. The purpose of this study was to investigate the effect of dexmedetomidine on analgesic and sedative treatment in patients with traumatic brain injury (TBI). Methods: selected from January 2014 to December 2015 in Tianjin People's Hospital. 120 patients with traumatic brain injury (TBI) were randomly divided into right metoimidin group (n=60) and hibernation mixture group (n=60 cases), and two groups of patients in the right metoimidine group and hibernation mixture group were in age, sex ratio, weight, and GCS score after the statistical software analysis. There was no statistical difference. There was a comparability. The load dose of right metomomidin group (2ml:200 mu g, Jiangsu Heng Rui Limited by Share Ltd) was 0.5-1.0 u g/kg, 10min was continuously pumped, and then 0.2-0.7 mu g. Kg-1. H-1 was maintained for 3 days; the hibernating group was injected with hibernation mixture (Chlorpromazine Hydrochloride Injection, 2ml:50mg,). Shanghai Hefeng Pharmaceutical Co., Ltd., Promethazine Hydrochloride Injection, 2ml:50mg, Tianjin Jin Yao Pharmaceutical Co., Pethidine Hydrochloride Injection, 2ml:100mg, Yichang fufu Pharmaceutical Co., Ltd., were administered once, for 3 days at intervals of 8 hours. The age, sex ratio, weight, and GCS score of the right metoimidin group and the hibernation mixture group were carried out. Comparison, records of two groups of patients with right metoimidin group and hibernation mixture group, heart rate, mean arterial pressure (MAP), respiratory frequency, oxygen saturation (SpO2), 24h blood pressure fluctuation, 1 days after medication, 3 days after medication, 3 days after medication, 5 days after medication, 5 days after medication, and within 7 days after medication. The adverse reactions and complications (bradycardia, hypotension, stress ulcers, lung infection, etc.) in the dexmedetomidine group (shallow sedation group and deep sedation group) and hibernation mixture group, the number of ICU days and total hospitalization days, and the prognosis of the patients after 6 months of follow-up (the Glasgow prognosis score GOS) were counted. Results: 1. the age (36.2 + 10.8 years), sex (male and female ratio 38/22), weight (68.3 + 13.2kg), GCS score (10.8 + 3.2), age (34.6 + 11.2 years), sex (43/17), weight (65.5 + 11.5kg), and GCS score (10.2 + 2.6)) were not statistically significant (P0.05) heart rate after.2.. Compared with the blood pressure, the heart rate of 1H right metomomimidin group was 72.4 + 7.8 / min and the blood pressure was 87.8 + 8.1mmHg, compared with before the medication, but the heart rate of the hibernation mixture group was 66.2 + 7.6 / min, and the blood pressure was 87.8 + 8.1 mmHg, and the blood oxygen saturation was 96.4 + 2. in right metoimidin group and hibernation mixture group (96.4 + 2.) after drug use. 9, the hibernation mixture group 96.2 + 2.1) had no obvious changes in.3. right metomomidin group and hibernation mixture group two patients after admission to the hospital continued to increase, third Tianda peak, right metoimidin group was 32.8 7.1mg/L, the hibernation mixture group was 41.2 + 7.9mg/L, but the right metoimidin group used 1 days after the C- reaction protein increase than the hibernating mixture group was obvious. The C- reaction protein content in right metoimidin group and hibernation mixture group was 28.5 + 6.2mg/L, 34.8 + 7.2mg/L.4. bradycardia, hypotension, stress ulcer, lung infection rate compared, right metoimidin group was 13,10,7,8, hibernating group was 23,20,16,17, right metoimidin group was significantly lower than hibernation In the mixture group, while in the right metoimidin group, the shallow sedation group (3 bradycardia, 2 hypotension, 1 stress ulcer, 1 lung infection) was significantly lower than the deep sedation group (10 times of bradycardia, 8 hypotension, 6 stress ulcers and 7 lung infection) in the.5. right metoimidin group (12.8 + 5.5 days). The total hospitalization time (21.2 + 6.5 days) compared with the ICU hospitalization time of the hibernation mixture group (15.3 + 6.1 days) and the total hospitalization time (28.5 + 7.4 days) significantly shortened the follow-up for 6 months after.6. injury. The prognosis of the right metoimidin group and the hibernation mixture group was two, the number of GOS1-5 scores in the prognosis score of Glasgow was compared, and the right metoimidin group was 3,5,10,15,27, respectively. The hibernation mixture group was 5,9,13,16,17, and the group was compared with Ridit analysis (R value dexmedetomidin =0.552, R value hibernation mixture =0.448, P=0.048), right metoimidin group was better than hibernation mixture group, but there was no significant difference between right metoimidin group and hibernation mixture group (5% vs.8.3%). Conclusion: 1. patients with traumatic brain injury (TBI) use right beauty. The effect of TMD is satisfactory, and the effect is remarkable. It can keep the patients awake at any time, and have no obvious influence on the respiratory and circulatory system..2. right metoomidin can obviously reduce the level of C- reaction protein, inhibit the inflammatory reaction, shorten the time of hospitalization and improve the patient's precondition, which is suitable for the town of brain trauma restless patients in Department of neurosurgery. In the treatment of.3. with dexmedetomidin, shallow sedation can reduce the incidence of adverse reactions and complications. In clinical work, we should monitor the depth of sedation and maintain a relatively shallow sedation.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
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