【摘要】 目的探讨术中不同剂量右美托咪定静脉维持对重症颅脑损伤患者镇静镇痛的效果。方法经本院伦理委员会批准后将2019年1月-2021年3月江门市中心医院收治的58例重症颅脑损伤患者按照随机数字表法分为两组,所有患者家属均签署同意书。研究1组29例予以0.3μg/(kg·h)右美托咪定静脉维持,研究2组29例予以0.5μg/(kg·h)右美托咪定静脉维持。比较两组手术时间、麻醉时间、舒芬太尼用量以及不同时刻Ramsay镇静评分、视觉模拟评分(VAS)、格拉斯哥昏迷指数(GCS)、血流动力学指标差异情况。结果两组手术时间、麻醉时间比较差异无统计学意义(P>0.05),研究2组舒芬太尼用量少于研究1组(P<0.05)。两组VAS评分和GCS评分呈升高趋势,Ramsay评分呈降低趋势,且研究2组HR、RR、MAP水平低于研究1组(P<0.05)。研究2组Ramsay评分、VAS评分低于研究1组,GCS评分高于研究1组(P>0.05)。研究2组不同时刻HR、RR、MAP水平低于研究1组(P<0.05)。结论术中予以0.5μg/(kg·h)右美托咪定静脉维持在重症颅脑损伤患者中应用相较于0.3μg/(kg·h)静脉维持具有更好的镇痛、镇静作用,可有效稳定血流动力学,患者意识状态情况更好,且舒芬太尼用量较少。更多还原

【Abstract】 Objective To investigate the effect of intravenous maintenance with different doses of dexmedetomidine during operation on the sedation and analgesia of patients with severe head injury.Methods After approval by the ethics committee of our hospital,58 patients with severe head injury who were admitted to Jiangmen Central Hospital between January 2019 and March 2021 were divided into two groups according to the random number table method,and all the patients’ family members signed the consent form.In Study 1 group,29 patients received 0.3μg/(kg·h) dexmedetomidine was maintained intravenously and 0.5μg/(kg·h) dexmedetomidine maintenance intravenously.The operation time,anesthesia time,sufentanil dosage as well as Ramsay Sedation score,visual analog scale (VAS),Glasgow Coma Scale (GCS),and hemodynamic indexes were compared between the two groups.Results There were no significant differences between the two groups in operation time or anesthesia time (P>0.05),and sufentanil use was less in Study 2 group than in Study 1 group (P<0.05).VAS scores and GCS scores tended to increase in both groups,Ramsay scores tended to decrease,and the levels of HR,RR,and map in Study 2 were lower than those in Study 1 (P<0.05).Ramsay and VAS scores were lower and GCS scores higher in Study 2 than study 1 (P>0.05).HR,RR and map levels at different times in Study 2 group were lower than those in Study 1 group (P<0.05).Conclusions During surgery 0.5μg/(kg·h) dexmedetomidine intravenous maintenance in patients with severe head injury compared to 0.3μg/(kg·h) intravenous maintenance has better analgesia and sedation,effectively stabilizes hemodynamics,better patient conscious state,and less sufentanil.更多还原