地佐辛对创伤性脑损伤(TBI)术后患者血流动力学指标的影响——一项初步研究。

Effect of Dezocine on Hemodynamic Indexes of Postoperative Patients With Traumatic Brain Injury (TBI)---A Pilot Study.

作者信息

Wang Xuejian, Chen Yang, Wang Zhifeng, Zhang Yi, Cui Zhiming, Sun Chen

机构信息

Department of Neurosurgery, Affiliated Hospital 2 of Nantong University, Nantong University, Nantong, China.

出版信息

Front Pharmacol. 2022 Mar 31;13:665107. doi: 10.3389/fphar.2022.665107. eCollection 2022.

Abstract

Due to pain and other stimuli, patients with traumatic brain injury (TBI) after surgery show excited Sympathetic Nervous system, increased intracranial pressure, brain tissue swelling, intracranial hemorrhage, or reduced cerebral perfusion pressure, seriously threatening the life and prognosis of patients. The effect of dezocine on postoperative analgesia after TBI remains largely undetermined. In the present study, we aimed to investigate the efficacy and safety of dezocine in postoperative sedative and analgesic therapy for a craniocerebral injury. The patients were randomly divided into two groups (n = 40) as follows: dezocine group (Group A) and control group (Group B). Electrocardiography (ECG), heart rate (HR), blood pressure, and oxygen saturation (SpO) were routinely monitored after postoperative return to the ward. Both groups were initially injected with 5 mg·kg·h propofol to maintain sedation, and the dose was adjusted according to the patient's condition. Vital signs of patients were recorded at T1 (the base value when arriving at the ward), T2 (before the sedative agent was used) and T3 (use of dezocine or 0.9% saline solution for 8 h), T4 (use for 1 day), T5 (use for 3 days), T6 (termination of dezocine or 0.9% saline solution for 1 day), and T7 (termination for 3 days), and mean arterial pressure (MAP) and HR values were also recorded. The total amount of propofol, total fluid inflow, blood loss, and urine output were recorded within 24 h. The number of coughs of each patient was recorded within 1 day after entry, and the incidence of adverse events, such as insufficient oxygenation (SaO reduced by about 5% from the base value), hypotension, bradycardia, laryngospasm, bronchospasm, and so on, was assessed. Compared with the control group (group B), the hemodynamics of the dezocine group (group A) was more stable, there were significant differences in MAP and HR ( < 0.05), and the stress response was milder. The total amount of propofol, total fluid inflow, blood loss, and urine volume of the dezocine group were significantly improved compared with the control group ( < 0.05). Moreover, the incidence of adverse events, such as cough, in the dezocine group was significantly reduced compared with the control group ( < 0.05). Dezocine, as a drug with a strong analgesic effect and obvious sedative effect, was suitable for craniocervical surgery, and it could significantly improve the stability of airway and hemodynamics in TBI patients during anesthesia recovery.

摘要

由于疼痛和其他刺激,创伤性脑损伤(TBI)患者术后会出现交感神经系统兴奋、颅内压升高、脑组织肿胀、颅内出血或脑灌注压降低,严重威胁患者生命和预后。地佐辛对TBI术后镇痛的效果在很大程度上仍未确定。在本研究中,我们旨在探讨地佐辛在颅脑损伤术后镇静镇痛治疗中的有效性和安全性。将患者随机分为两组(n = 40):地佐辛组(A组)和对照组(B组)。术后返回病房后常规监测心电图(ECG)、心率(HR)、血压和血氧饱和度(SpO)。两组均先静脉注射丙泊酚5 mg·kg·h以维持镇静,并根据患者情况调整剂量。记录患者在T1(到达病房时的基础值)、T2(使用镇静剂前)、T3(使用地佐辛或0.9%盐水溶液8小时)、T4(使用1天)、T5(使用3天)、T6(停用1天地佐辛或0.9%盐水溶液)和T7(停用3天)时的生命体征,并记录平均动脉压(MAP)和HR值。记录24小时内丙泊酚总量、总液体入量、失血量和尿量。记录每位患者入室后1天内的咳嗽次数,并评估不良事件的发生率,如氧合不足(SaO较基础值降低约5%)、低血压、心动过缓、喉痉挛、支气管痉挛等。与对照组(B组)相比,地佐辛组(A组)的血流动力学更稳定,MAP和HR有显著差异(P < 0.05),应激反应更轻。地佐辛组的丙泊酚总量、总液体入量、失血量和尿量与对照组相比有显著改善(P < 0.05)。此外,地佐辛组咳嗽等不良事件的发生率与对照组相比显著降低(P < 0.05)。地佐辛作为一种镇痛作用强、镇静效果明显的药物,适用于颅脑手术,可显著提高TBI患者麻醉恢复期间气道和血流动力学的稳定性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/098e/9008756/9485002878ec/fphar-13-665107-g001.jpg

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