右美托咪定在創(chuàng)傷性腦損傷患者鎮(zhèn)靜治療中的應(yīng)用研究
發(fā)布時(shí)間：2018-07-15 11:57
【摘要】：目的:右美托咪定作為一種相對(duì)比較新的鎮(zhèn)靜藥物,其在神經(jīng)外科中的應(yīng)用缺乏臨床證據(jù),本研究旨在研究探討右美托咪定在創(chuàng)傷性腦損傷(TBI)患者鎮(zhèn)痛鎮(zhèn)靜治療中的作用療效。方法:選取2014年1月至2015年12月天津市人民醫(yī)院神經(jīng)外科收治的120例創(chuàng)傷性腦損傷(TBI)患者為研究對(duì)象,按照隨機(jī)數(shù)字表法隨機(jī)分為右美托咪定組(n=60例)和冬眠合劑組(n=60例)(分組采用隨機(jī)分配,并經(jīng)統(tǒng)計(jì)軟件分析后右美托咪定組和冬眠合劑組兩組患者在年齡、男女性別比例、體重、GCS評(píng)分方面的比較差異無(wú)統(tǒng)計(jì)學(xué)意義,有可比性,右美托咪定組給予右美托咪定(2ml:200μg,江蘇恒瑞醫(yī)藥股份有限公司)負(fù)荷劑量為0.5-1.0μg/kg,持續(xù)泵注10min,后以0.2-0.7μg·kg-1·h-1速度維持3天;冬眠合劑組肌注冬眠合劑(鹽酸氯丙嗪注射液,2ml:50mg,上海禾豐制藥有限公司;鹽酸異丙嗪注射液,2ml:50mg,天津金耀藥業(yè)有限公司;鹽酸哌替啶注射液,2ml:100mg,宜昌人福藥業(yè)有限責(zé)任公司),間隔8小時(shí)給藥一次,維持3天。對(duì)右美托咪定組和冬眠合劑組兩組患者年齡、性別比例、體重、GCS評(píng)分進(jìn)行比較,記錄右美托咪定組和冬眠合劑組兩組患者用藥前、用藥后1h、用藥后4h時(shí)心率、平均動(dòng)脈壓(MAP)、呼吸頻率、血氧飽和度(SpO2)變化,24h血壓波動(dòng)幅度,以及用藥前、用藥后1天、用藥后3天、用藥后5天C-反應(yīng)蛋白含量的變化,對(duì)比用藥后7天內(nèi)右美托咪定組(淺鎮(zhèn)靜組及深鎮(zhèn)靜組)與冬眠合劑組不良反應(yīng)及并發(fā)癥(心動(dòng)過(guò)緩、低血壓、應(yīng)激性潰瘍、肺部感染等)發(fā)生情況、ICU住院天數(shù)及總住院天數(shù),以及隨訪患者6個(gè)月后患者的預(yù)后情況(格拉斯哥預(yù)后評(píng)分GOS)等因素進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:1.右美托咪定組患者年齡(36.2±10.8歲)、性別(男女比例38/22)、體重(68.3±13.2kg)、GCS評(píng)分(10.8±3.2分),與冬眠合劑組年齡(34.6±11.2歲)、性別(男女比例43/17)、體重(65.5±11.5kg)、GCS評(píng)分(10.2±2.6分)等比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.用藥后心率及血壓比較,用藥后1h右美托咪定組,心率72.4±7.8次/分,血壓87.8±8.1mmHg,相較于用藥前無(wú)較大變化,但冬眠合劑組心率66.2±7.6次/分,血壓87.8±8.1 mmHg明顯降低。而用藥后右美托咪定組和冬眠合劑組兩組患者血氧飽和度(右美托咪定組96.4±2.9,冬眠合劑組96.2±2.1)均無(wú)明顯變化。3.右美托咪定組和冬眠合劑組兩組患者C-反應(yīng)蛋白入院后均持續(xù)升高,第3天達(dá)峰值,右美托咪定組為32.8±7.1mg/L,冬眠合劑組為41.2±7.9mg/L,但右美托咪定組用藥1天后C-反應(yīng)蛋白增幅較冬眠合劑組明顯降低,用藥后右美托咪定組和冬眠合劑組的C-反應(yīng)蛋白含量分別為28.5±6.2mg/L、34.8±7.2mg/L。4.心動(dòng)過(guò)緩、低血壓、應(yīng)激性潰瘍、肺部感染發(fā)生率比較,右美托咪定組發(fā)生人次分別為13、10、7、8,冬眠合劑組則為23、20、16、17,右美托咪定組顯著低于冬眠合劑組,而在右美托咪定組組內(nèi)比較時(shí),淺鎮(zhèn)靜組(心動(dòng)過(guò)緩3人次、低血壓2人次、應(yīng)激性潰瘍1人、肺部感染1人)明顯低于深鎮(zhèn)靜組(心動(dòng)過(guò)緩10人次、低血壓8人次、應(yīng)激性潰瘍6人、肺部感染7人)。5.右美托咪定組患者的ICU住院時(shí)間(12.8±5.5日)及總住院時(shí)間(21.2±6.5日)相較于冬眠合劑組的ICU住院時(shí)間(15.3±6.1日)及總住院時(shí)間(28.5±7.4日)均顯著縮短。6.傷后6個(gè)月隨訪,右美托咪定組和冬眠合劑組兩組預(yù)后,格拉斯哥預(yù)后評(píng)分GOS1-5分的人數(shù)比較,右美托咪定組分別為3、5、10、15、27人,而冬眠合劑組則分別為5、9、13、16、17人,組間比較采用Ridit分析(R值右美托咪定=0.552,R值冬眠合劑=0.448,P=0.048),右美托咪定組好于冬眠合劑組。但右美托咪定組與冬眠合劑組的病死率無(wú)顯著差別(5%vs.8.3%)。結(jié)論:1.創(chuàng)傷性腦損傷(TBI)患者應(yīng)用右美托咪定鎮(zhèn)靜治療效果滿(mǎn)意,作用顯著,可使患者隨時(shí)保持可喚醒狀態(tài),且對(duì)呼吸及循環(huán)系統(tǒng)無(wú)明顯影響。2.右美托咪定可以明顯降低C-反應(yīng)蛋白水平,抑制炎性反應(yīng),縮短住院時(shí)間,改善患者的預(yù)后,適用于神經(jīng)外科顱腦外傷躁動(dòng)患者的鎮(zhèn)靜治療。3.應(yīng)用右美托咪定鎮(zhèn)靜時(shí),淺鎮(zhèn)靜能減少不良反應(yīng)及并發(fā)癥的發(fā)生,在臨床工作中應(yīng)注意監(jiān)測(cè)鎮(zhèn)靜深度,維持較淺的鎮(zhèn)靜狀態(tài)。
[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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R614
本文編號(hào)：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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R614
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，本文編號(hào)：2123996
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