异丙酚对行气管内吸痰的严重脑部疾病患者颅内压和预后的影响。
Effects of propofol on intracranial pressure and prognosis in patients with severe brain diseases undergoing endotracheal suctioning.
机构信息
West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China.
Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, P. R. China.
出版信息
BMC Neurol. 2020 Oct 29;20(1):394. doi: 10.1186/s12883-020-01972-1.
BACKGROUND
To investigate whether the administration of intravenous propofol before endotracheal suctioning (ES) in patients with severe brain disease can reduce the sputum suction response, improve prognosis, and accelerate recovery.
METHODS
A total of 208 severe brain disease patients after craniocerebral surgery were enrolled in the study. The subjects were randomly assigned to the experimental group (n = 104) and the control group (n = 104). The experimental group was given intravenous propofol (10 ml propofol with 1 ml 2% lidocaine), 0.5-1 mg/kg, before ES, while the control group was subjected to ES only. Changes in vital signs, sputum suction effect, the fluctuation range of intracranial pressure (ICP) before and after ES, choking cough response, short-term complications, length of stay, and hospitalization cost were evaluated. Additionally, the Glasgow Outcome Scale (GOS) prognosis score was obtained at 6 months after the operation.
RESULTS
At the baseline, the characteristics of the two groups were comparable (P > 0.05). The increase of systolic blood pressure after ES was higher in the control group than in the experimental group (P < 0.05). The average peak value of ICP in the experimental group during the suctioning (15.57 ± 12.31 mmHg) was lower than in the control group (18.24 ± 8.99 mmHg; P < 0.05). The percentage of patients experiencing cough reaction- during suctioning in the experimental group was lower than in the control group (P < 0.05), and the fluctuation range of ICP was increased (P < 0.0001). The effect of ES was achieved in both groups. The incidence of short-term complications in the two groups was comparable (P > 0.05). At 6 months after the surgery, the GOS scores were significantly higher in the experimental than in the control group (4-5 points, 51.54% vs. 32.64%; 1-3 points, 48.46% vs. 67.36%; P < 0.05). There was no significant difference in the length of stay and hospitalization cost between the two groups.
CONCLUSIONS
Propofol sedation before ES could reduce choking cough response and intracranial hypertension response. The use of propofol was safe and improved the long-term prognosis. The study was registered in the Chinese Clinical Trial Registry on May 16, 2015 (ChiCTR-IOR-15006441).
背景
研究在重症颅脑疾病患者行气管内吸痰（ES）前给予静脉注射异丙酚是否能减轻吸痰反应，改善预后，加快康复。
方法
将 208 例颅脑手术后重症颅脑疾病患者纳入本研究，采用随机数字表法将患者分为实验组（n=104）和对照组（n=104）。实验组在 ES 前给予异丙酚（10 ml 异丙酚+1 ml 2%利多卡因，0.5-1 mg/kg），对照组仅行 ES。观察两组患者生命体征变化、吸痰效果、ES 前后颅内压（ICP）波动范围、呛咳反应、短期并发症、住院时间、住院费用，术后 6 个月采用 Glasgow 预后评分（GOS）评估预后。
结果
两组患者一般资料比较差异无统计学意义（P>0.05）。与对照组比较，实验组 ES 后收缩压升高幅度较小（P<0.05）；实验组吸痰时平均 ICP 峰值（15.57±12.31mmHg）低于对照组（18.24±8.99mmHg；P<0.05）；实验组呛咳反应发生率低于对照组（P<0.05），ICP 波动幅度增大（P<0.0001）。两组 ES 效果均满意，短期并发症发生率比较差异无统计学意义（P>0.05）。术后 6 个月实验组 GOS 评分 4-5 分者占比高于对照组（51.54%比 32.64%），1-3 分者占比低于对照组（48.46%比 67.36%），差异均有统计学意义（P<0.05）。两组住院时间、住院费用比较差异无统计学意义。
结论
ES 前给予异丙酚镇静可减轻呛咳反应及颅内高压反应，使用安全，能改善患者的远期预后。本研究已在中国临床试验注册中心登记，注册号 ChiCTR-IOR-15006441。
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