【摘要】 目的 探讨右美托咪定联合布托啡诺对重度颅脑损伤患者镇痛镇静效果及对心脑保护的作用。方法 选取2016年8月—2021年8月收治的重度颅脑损伤205例，依据镇痛镇静方案不同分为研究组103例和对照组102例。对照组予右美托咪定静脉泵注，研究组在对照组基础上联合布托啡诺静脉泵注。比较2组给药前及给药后24、72 h血流动力学指标[平均动脉压(MAP)、心率(HR)],心肌损伤指标[心肌型肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)],脑损伤指标[神经元特异性烯醇化酶(NSE)、中枢神经特异性蛋白(S100β)、神经元PAS结构域蛋白4(NPAS4)]水平，Richmond躁动-镇静评分(RASS)、不良反应发生率及重症监护病房(ICU)住院时间、总住院时间、给药后14 d格拉斯哥昏迷评分(GCS)、给药后28 d格拉斯哥预后量表(GOS)评分。结果 与给药前比较，2组给药后24、72 h MAP、HR与血清CK-MB、cTnI、NSE、S100β、NPAS4水平均降低，且研究组降低更显著(P<0.05,P<0.01)。2组给药后12、24 h RASS评分均较给药前降低，且研究组降低更显著(P<0.05,P<0.01)。研究组ICU住院时间、总住院时间较对照组短，给药后14 d GCS评分、给药后28 d GOS评分较对照组高(P<0.01)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论 右美托咪定联合布托啡诺可显著提升重度颅脑损伤患者镇痛镇静效果，促进血流动力学稳定，缓解心脑损伤，利于患者康复及预后改善，且安全性好。更多还原

【Abstract】 Objective To investigate the effect of Dexmedetomidine combined with Butorphanol on analgesia, sedation and cardio-cerebral protection in patients with severe craniocerebral injury(SCCI). Methods A total of 205 patients with SCCI in our hospital from August 2016 to August 2021 were selected and divided into the research group(n=103) and the control group(n=102) according to different analgesic and sedative regimens. The control group was given intravenous injection of Dexmedetomidine, and the research group was given intravenous injection of Butorphanol on the basis of the control group. Hemodynamic indexes [mean arterial pressure(MAP), heart rate(HR)] and myocardial injury indexes [cardiac creatine kinase isoenzyme(CK-MB), cardiac troponin I(cTnI)], brain injury indicators [neuron-specific enolase(NSE), central nervous system-specific protein(S100β), neuronal PAS domain protein 4(NPAS4)] levels, Richmond restlessness-sedation score(RASS), incidence of adverse reactions, length of stay in intensive care unit(ICU), total length of hospital stay, Glasgow coma scale(GCS) score at 14 d after administration, Glasgow outcome scale(GOS) at 28 d after administration score were compared before administration and at 24 and 72 h after administration between the two groups. Results Compared with those before administration, the levels of MAP, HR and serum CK-MB, cTnI, NSE, S100β and NPAS4 in the two groups were decreased at 24 and 72 h after administration, and the decrease in the research group was more significant(P<0.05, P<0.01). The RASS scores at 12 and 24 h after administration in both groups were lower than those before administration, and the decrease in the research group was more significant(P<0.05, P<0.01). The length of ICU stay and total length of hospital stay in the research group were shorter than those in the control group, and the GCS scores at 14 d after administration and the GOS score at 28 d after administration were higher than those in the control group(P<0.01). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion Dexmedetomidine combined with Butorphanol can significantly improve the analgesic and sedative effect in patients with SCCI, promote hemodynamic stability, and relieve heart and brain injury, which is conductive to the recovery of patients and improvement in prognosis, and has good safety.更多还原