The clinical value of deep sedation in the treatment of severe craniocerebral injury
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摘要: 目的 研究深镇静对重型颅脑损伤患者术后应用的有效性。 方法 选取东方肝胆外科医院2013年6月—2016年6月常规治疗联合深镇静(BIS:2040)治疗的37例重度颅脑损伤患者为试验组,而同时期未行深镇静(BIS:4060)治疗的41例重度颅脑损伤患者为对照组。2组患者均采用镇静镇痛、容量管理、机械通气、营养支持等治疗措施。治疗期间严密监测患者的生命体征,当出现血压明显下降、氧饱和度降低,调整镇静药物泵入剂量及呼吸机参数。根据血气结果观察2组患者的颈静脉氧饱和度(Sjv O2)、动脉-颈静脉氧含量差(AVDO2)、脑氧摄取率(CEO2)指标。采用床旁彩超高频线阵探头测量2组患者视神经鞘直径(ONSD)值。采用低频微凸阵探头测量2组患者大脑中动脉的舒张末期流速(Vd)和脉动指数(PI)。比较2组治疗效果。 结果 试验组治疗第7天平均ONSD值(4.98±0.09)显著低于对照组(5.95±0.05),差异具有统计学意义(P<0.01)。试验组治疗第7天Vd升高、PI下降,与对照组相比,差异具有统计学意义(P<0.01)。试验组治疗第7天Sjv O2上升、AVDO2下降、CEO2下降,与对照组相比,差异具有统计学意义(P<0.01)。 结论 深镇静降低重度颅脑损伤颅内压、改善脑氧代谢,值得在临床推广使用。Abstract: Objective To study the effect of deep sedation on severe craniocerebral injury patients after operation. Methods Thirty-seven patients with severe traumatic brain injury from June, 2013 to June, 2016 were treated with routine treatment and deep sedation (BIS:20-40). At the same time 41 patients with severe traumatic brain injury who were not treated by deep sedation (BIS:40-60) were the control group. Two groups of patients had sedative and analgesia treatment, capacity management, mechanical ventilation, nutritional support and other treatment measures. Blood samples were taken to observe the Sj O2, AVDO2 and CEO2indexes of the two groups. The ONSD values of the two groups were measured by bedside color high frequency linear array probe. The diastolic Vd and PI of the middle cerebral artery of the two groups were measured by low frequency micro-convex array probe. We compared the two groups of treatment. Results The mean ONSD (4. 98 ±0. 09) was significantly lower in the experimental group than that in the control group (5. 95 ±0. 05) at the7 th day. The difference was statistically significant (P < 0. 01). In the experimental group, Vd increased and PI decreased at the 7th day. Compared with the control group, the difference was statistically significant (P < 0. 01). In the experimental group, Sjv O2 increased, but AVDO2 and CEO2decreased at the 7th day. Compared with the control group, the difference was statistically significant (P < 0. 01). Conclusion Deep sedation in severe traumatic brain injury can decrease intracranial pressure and improve cerebral oxygen metabolism, which is worth popularizing in clinic.
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Key words:
- Deep sedation /
- Severe traumatic brain injury /
- Treatment
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