Objective To explore the sedative effect of dexmedetomidine on patients with mild to moderate traumatic brain injury after operation and on intracranial pressure （ICP）. Methods A total of 180 patients with mild to moderate traumatic brain injury meeting designed inclusion criteria were enrolled as study subjects, and were divided into group A （dexmedetomidine）, group B （dexmedetomidine + propofol）, and group C （midazolam） by the random number table method. The Richmond Agitation Sedation Scale （RASS） score, ICP, changes of cerebral perfusion pressure （CPP）, and occurrence of hypotension and bradycardia were recorded before surgery （T1）, 1 h （T2）, 2 h （T3）, 6 h （T4）, 12 h （T5）, and 24 h （T6） after surgery. Results The RASS scores and Critical-care Pain Observation Tool （CPOT） scores of group A, group B, and group C at T1-T3 were not significantly different （P>0.05）. The RASS score and CPOT scores of group A and group B at T4-T6 were significantly lower than those of group C （P>0.05）. The proportions of optimal sedation （RASS score at -2 to +1） of group A and group B at T4-T6 were significantly higher than that of group C （P>0.05）, the proportions of over sedation （RASS score < -2） of group B at the same time points were higher than those of group A （P>0.05）, and the proportions of agitation （RASS score > +1） of group C at the same time points were higher than those of group A and group B （P>0.05）. The ICP values of group A and group B at T3-T5 were significantly lower than the values of group C （P>0.05）, and no difference in the lCP values were found between group A and group B at all time points. There was no difference in CPP at all time points （P=0.06） and the incidence rates of hypotension and bradycardia （P=0.15） among the three groups. Conclusion Dexmedetomidine produces a safe and reliable sedative effect on patients with mild to moderate traumatic brain injury after operation, and tends to achieve optimal sedation （RASS score at -2 to +1）.
XING Chunfeng
,
LUO Weixiang
,
ZHOU Yuehui
,
FANG Yuanyuan
. Effect of dexmedetomidine on sedation and intracranial hypertension of patients with mild to moderate traumatic brain injury after operation[J]. Surgical Research and New Technique, 2023
, 12(3)
: 192
-196
.
DOI: 10.3969/j.issn.2095-378X.2023.03.009
[1] 文欣荣,刘畅,陈林,等.右旋美托咪定复合帕瑞昔布对老年患者术后认知功能的影响[J]. 局解手术学杂志,2015,24(6):612-615.
[2] 刘锦,俞梦瑾,刘晖.右旋美托咪定对高血压脑出血钻孔引流术后患者SAS评分及Ramsay评分的影响[J]. 心血管康复医学杂志,2016,25(6):620-622.
[3] Shehabi Y, Chan L, Kadiman S, et al.Sedation depth and long-term mortalityin mechanically ventilated critically ill adults: a prospective longitudinal multicentre cohort study[J]. Intensive Care Med, 2013, 39(5): 910-918.
[4] Oddo M, Crippa IA, Mehta S, et al.Optimizing sedation in patients with acute brain injury[J]. Crit Care, 2016, 20(1): 128.
[5] 中国医师协会神经外科医师分会,中国神经创伤专家委员会.中国颅脑创伤颅内压监测专家共识[J]. 中华神经外科杂志,2011,27(10):1073-1074.
[6] 赵军魁,回丽妹,王云辉,等.右美托咪定对重度颅脑损伤患者血浆S100B蛋白及颅内压的影响[J]. 中国急救医学,2013,33(8):723-726.
[7] Shehabi Y, Bellomo R, Reade MC, et al.Early goal-directed sedation versus standard sedation in mechanically ventilated critically ill patients: a pilot study[J]. Crit Care Med, 2013, 41(8): 1984-1990.
[8] 张磊,潘志浩,李炎.右美托咪定对重型颅脑损伤患者围术期免疫功能的影响[J]. 中国临床药学杂志,2019,28(2): 101-105.
[9] 杨贵荣,郭晓东,毛更生,等.早期目标导向镇静在急性脑损伤中的应用[J]. 中华危重病急救医学,2020,32(3): 345-349.
[10] 王淑梅.右美托咪定在重型颅脑外伤手术麻醉中的脑保护作用分析[J]. 临床医药文献电子杂志,2020,7(54):47,50.
[11] 赵瑟. 右美托咪定联合舒芬太尼对重症颅脑损伤患者血流动力学水平的影响及安全性分析[J]. 现代医学与健康研究电子杂志,2020,4(21):21-22.
[12] 宋贺,门焕丽,张花平,等.右美托咪定术中不同给药剂量对重症颅脑损伤患者镇静镇痛、血流动力学及脑氧代谢的影响[J]. 河北医科大学学报,2019,40(12):1472-1476.
[13] 宋贺,张花平,邱延伟,等.右美托咪定对重症颅脑损伤患者围术期脑组织的保护作用及对血清炎性因子的影响[J]. 中国医院用药评价与分析,2019,19(5):530-533.
[14] 赵静宜. 右美托咪定对重型颅脑外伤患者脑氧代谢及血浆NSE,S100β蛋白水平的影响[J]. 实用中西医结合临床,2020,20(4):146-148.
[15] 李钊,祁景,王艮卫.右美托咪定对重症颅脑损伤术后患者脑氧代谢率和脑血流的影响[J]. 中国实用神经疾病杂志,2020,23(13):1165-1168.
