程序化镇痛镇静联合适度过度通气对重症颅脑损伤患者术后苏醒时间及认知功能的影响

doi:10.3969/j.issn.1671-7171.2020.01.005

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摘要 【目的】 探讨程序化镇静镇痛联合适度过度通气对重症颅脑损伤患者术后苏醒时间及认知功能的影响。【方法】 本院治疗的90例重症颅脑损伤患者,随机分成两组,各45例,对照组采用适度过度通气治疗,观察组在对照组的基础上使用程序化镇痛治疗。比较两组患者的脑氧耗监测指标[颅内压(ICP)、颈内静脉血氧饱和度(SjO₂)、脑氧摄取率 (CEO₂ )、和脑动静脉氧差 (AVDO₂ )]、术后苏醒时间、镇静镇痛效果及认知功能的差异。【结果】 治疗后观察组的ICP与SjO₂明显高于对照组(P＜0.05),而CEO₂与AVDO₂明显低于对照组(P＜0.05);观察组的苏醒时间、拔管时间及说话时间明显比对照组短(P＜0.05);观察组的Ricker镇静-躁动评分(SAS)、疼痛视觉模拟评分(VAS)与Ramsay镇静评分(RSS)明显低于对照组(P＜0.05);观察组的认知功能有效率显著高于对照组(P＜0.05)。【结论】 在重症颅脑损伤的治疗过程中,采用程序化镇静镇痛联合适度过度通气治疗,可充分镇痛,减轻应激反应和脑氧耗,对患者产生良好的脑保护作用。

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关键词 ：颅脑损伤/外科学, 危重病, 镇痛, 麻醉恢复期

Abstract：【Objective】To explore the effect of programmed sedation and analgesia combined with moderate hyperventilation on recovery time and cognitive function of patients with severe craniocerebral injury after operation.【Methods】Ninty cases of severe craniocerebral injury collected in our hospital were selected as the research objects. All the selected patients were randomly divided into two groups, 45 cases in each group. The control group was treated with moderate hyperventilation, while the observation group was treated with programmed analgesia on the basis of the control group. The monitoring indexes of cerebral oxygen consumption(ICP、SjO₂、CEO₂、AVDO₂), recovery time, sedative and analgesic effects and cognitive function were compared between the two groups. 【Results】ICP and SjO₂ in the observation group were significantly higher than those in the control group (P<0.05), while CEO₂ and AVDO₂ in the observation group were significantly lower than those in the control group (P<0.05); the recovery time, extubation time and speaking time in the observation group were significantly shorter than those in the control group (P<0.05); SAS, VAS and RSS scores in the observation group were significantly lower than those in the control group (P<0.05); the cognitive efficiency of the observation group was significantly higher than that of the control group (P<0.05).【Conclusion】During the treatment of severe craniocerebral injury, programmed sedation and analgesia combined with moderate hyperventilation can fully relieve pain, reduce stress, reduce brain oxygen consumption and produce good brain protection.

Key words： Craniocerebral Trauma/SU Critical Illness Analgesia Anesthesia Recovery Period

收稿日期: 2018-11-09

PACS:

R651.15

基金资助:四川省卫生厅科研课题(编号:20150855)

引用本文:

邹燕群. 程序化镇痛镇静联合适度过度通气对重症颅脑损伤患者术后苏醒时间及认知功能的影响[J]. 医学临床研究, 2020, 37(1): 12-14.
ZOU Yan-qun. Effects of Programmed Analgesia and Sedation Combined with Moderate Hyperventilation on Recovery Time and Cognitive Function in Patients with Severe Craniocerebral Injury. JOURNAL OF CLINICAL RESEARCH, 2020, 37(1): 12-14.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2020.01.005 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2020/V37/I1/12

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