咪达唑仑与丙泊酚镇静对单纯性重度颅脑损伤后神经损伤标志物及预后的影响：一项前瞻性研究。

Effect of midazolam versus propofol sedation on markers of neurological injury and outcome after isolated severe head injury: a pilot study.

作者信息

Ghori Kamran A, Harmon Dominic C, Elashaal Abdurrahim, Butler Mark, Walsh Fergus, O'Sullivan Michael G J, Shorten George D

机构信息

Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork, Ireland.

出版信息

Crit Care Resusc. 2007 Jun;9(2):166-71.

PMID:17536986

Abstract

BACKGROUND

Midazolam and propofol are sedative agents commonly administered to patients with brain injury. We compared plasma concentrations of glial cell S100beta protein and nitric oxide (NO) between patients who received midazolam and those who received propofol sedation after severe brain injury, and investigated the association between S100beta and NO concentrations and neurological outcome.

DESIGN

28 patients with severe head injury (Glasgow Coma Score <9) who required sedation and ventilation were randomly assigned to receive midazolam (n =15) or propofol (n = 13) based sedation. Blood samples were drawn daily for 5 days for estimation of S100beta and NO concentrations. Neurological outcome was assessed 3 months later as good (Glasgow Outcome Score [GOS], 4-5) or poor (GOS, 1-3).

RESULTS

A good neurological outcome was observed in 8/15 patients (53%) in the midazolam group and 7/13 patients (54%) in the propofol group. Patients with a poor outcome had higher serum S100beta concentrations on ICU admission and on Days 1-4 in the ICU than those with a good outcome (mean [SD] on Day 1, 0.99 [0.81] v 0.41 [0.4] microg/L; Day 2, 0.80 [0.81] v 0.41 [0.24] microg/L; Day 3, 0.52 [0.55] v 0.24 [0.25] microg/L; and Day 4, 0.54 [0.43] v 0.24 [0.35] microg/L; P<0.05). There was no significant difference on Day 5. Plasma NO concentrations were not associated with outcome. In subgroup analysis, there was no difference in S100beta and NO concentrations between patients with a good outcome versus those with a poor outcome in either the midazolam or propofol group.

CONCLUSIONS

Plasma concentrations of markers of neurological injury in patients with severe head injury were similar in those who received midazolam sedation and those who received propofol. Patients who had a poor neurological outcome at 3 months had consistently higher serum S100beta concentrations during the initial 4 days after injury than patients who had a good outcome.

摘要

背景

咪达唑仑和丙泊酚是常用于脑损伤患者的镇静剂。我们比较了重度脑损伤后接受咪达唑仑镇静和接受丙泊酚镇静患者的血浆胶质细胞S100β蛋白和一氧化氮（NO）浓度，并研究了S100β与NO浓度和神经功能结局之间的关联。

设计

28例需要镇静和通气的重度颅脑损伤患者（格拉斯哥昏迷评分<9）被随机分配接受基于咪达唑仑（n = 15）或丙泊酚（n = 13）的镇静。连续5天每天采集血样以测定S100β和NO浓度。3个月后评估神经功能结局为良好（格拉斯哥预后评分[GOS]，4 - 5）或不良（GOS，1 - 3）。

结果

咪达唑仑组15例患者中有8例（53%）神经功能结局良好，丙泊酚组13例患者中有7例（54%）神经功能结局良好。结局不良的患者在入住重症监护病房（ICU）时以及在ICU的第1 - 4天血清S100β浓度高于结局良好的患者（第1天均值[标准差]，0.99[0.81]对0.41[0.4]μg/L；第2天，0.80[0.81]对0.41[0.24]μg/L；第3天，0.52[0.55]对0.24[0.25]μg/L；第4天，0.54[0.43]对0.24[0.35]μg/L；P<0.05）。第5天无显著差异。血浆NO浓度与结局无关。在亚组分析中，咪达唑仑组或丙泊酚组中结局良好的患者与结局不良的患者之间S100β和NO浓度无差异。