Huang Yanxia, Deng Yunxin, Zhang Renjing, Meng Mei, Chen Dechang
Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201801, China.
Brain Sci. 2022 Jun 8;12(6):752. doi: 10.3390/brainsci12060752.
Studies have shown that dexmedetomidine improves neurological function. Whether dexmedetomidine reduces mortality or improves quantitative electroencephalography (qEEG) among patients post-craniotomy remains unclear.
This single-center randomized study was conducted prospectively from 1 January 2019 to 31 December 2020. Patients who were transferred to the ICU after craniotomy within 24 h were included. The analgesic was titrated to a Critical care Pain Observation Tool (CPOT) score ≤2, and the sedative was titrated to a Richmond Agitation-Sedation Scale (RASS) score ≤-3 for at least 24 h. The qEEG signals were collected by four electrodes (F3, T3, F4, and T4 according to the international 10/20 EEG electrode practice). The primary outcome was 28-day mortality and qEEG results on day 1 and day 3 after sedation.
One hundred and fifty-one patients were enrolled in this study, of whom 77 were in the dexmedetomidine group and 74 in the midazolam group. No significant difference was found between the two groups in mortality at 28 days (14.3% vs. 24.3%; = 0.117) as well as in the theta/beta ratio (TBR), the delta/alpha ratio (DAR), and the (delta + theta)/(alpha + beta) ratio (DTABR) between the two groups on day 1 or day 3. However, both the TBR and the DTABR were significantly increased in the dexmedetomidine group. The DTABR in the midazolam group was significantly increased. The DAR was significantly increased on the right side in the dexmedetomidine group (20.4 (11.6-43.3) vs. 35.1 (16.7-65.0), = 0.006) as well as on both sides in the midazolam group (Left: 19.5 (10.1-35.8) vs. 37.3 (19.3-75.7), = 0.006; Right: 18.9 (10.1-52.3) vs. 39.8 (17.5-99.9), = 0.002).
Compared with midazolam, dexmedetomidine did not lead to a lower 28-day mortality or better qEEG results in brain injury patients after a craniotomy.
研究表明右美托咪定可改善神经功能。右美托咪定是否能降低开颅术后患者的死亡率或改善定量脑电图（qEEG）仍不清楚。
本单中心随机研究于2019年1月1日至2020年12月31日前瞻性进行。纳入开颅术后24小时内转入重症监护病房（ICU）的患者。将镇痛药滴定至重症监护疼痛观察工具（CPOT）评分≤2，将镇静药滴定至里士满躁动镇静量表（RASS）评分≤ -3，持续至少24小时。通过四个电极（根据国际10/20脑电图电极规范为F3、T3、F4和T4）收集qEEG信号。主要结局为镇静后第1天和第3天的28天死亡率及qEEG结果。
本研究共纳入151例患者，其中右美托咪定组77例，咪达唑仑组74例。两组在28天死亡率（14.3%对24.3%；P = 0.117）以及第1天或第3天两组之间的θ/β比值（TBR）、δ/α比值（DAR）和（δ + θ）/（α + β）比值（DTABR）方面均无显著差异。然而，右美托咪定组的TBR和DTABR均显著升高。咪达唑仑组的DTABR显著升高。右美托咪定组右侧的DAR显著升高（20.4（11.6 - 43.3）对35.1（16.7 - 65.0），P = 0.006），咪达唑仑组两侧的DAR也显著升高（左侧：19.5（10.1 - 35.8）对37.3（19.3 - 75.7），P = 0.006；右侧：18.9（10.1 - 52.3）对39.8（17.5 - 99.9），P = 0.002）。
与咪达唑仑相比，右美托咪定在开颅术后脑损伤患者中并未导致更低的28天死亡率或更好的qEEG结果。
