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盐酸右美托咪定联合酒石酸布托啡诺治疗创伤性脑损伤的临床研究。

Clinical Study of Dexmedetomidine in Combination with Butorphanol for the Treatment of Traumatic Brain Injury (TBI).

机构信息

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

出版信息

Turk Neurosurg. 2024;34(1):14-19. doi: 10.5137/1019-5149.JTN.36585-21.2.

Abstract

AIM

To explore whether the combination of dexmedetomidine (Dex) and butorphanol (But) could benefit patients with traumatic brain injury (TBI).

MATERIAL AND METHODS

A total of 208 TBI patients admitted from February 2018 to January 2020 were randomly divided into four groups as follows: control group (A), Dex group (B), But group (C), and combination of dexmedetomidine and butorphanol group (D). Four groups of patients were treated and studied clinically. Statistical analysis was performed to assess the changes in signs of life, oxygen saturation, serum neuroendocrine data, pain, and agitation scores.

RESULTS

The statistical data of signs of life and blood oxygen saturation of the four groups were compared, and the differences between group A and group D were statistically significant (p < 0.05), indicating that a combination of sedative and analgesic agents at low doses could improve the signs of life of TBI patients, and the safety was relatively good. The Glasgow Coma Scale (GCS) score of the group D on the 5th day post-surgery was improved compared with the control group (A group), suggesting that the combination of sedative and analgesic agents could improve patients' consciousness. The neuroendocrine data of the combination group showed little fluctuation, indicating that a combination of sedative and analgesic agents could significantly reduce the stress response. The scores of pain and agitation in the combination group were significantly improved on the 3rd and 5th days, suggesting that the combination group was better compared with the control group.

CONCLUSION

The combination of Dex and But was more stable for the treatment of vital signs. Compared with the individual treatment groups, the patients in the combination group had a rapid improvement. The time from treatment to stabilization was shortened, and the prognosis was significantly better compared with the control group. A combination of Dex and But at low doses could significantly maintain neuroendocrine stability. Meanwhile, a combination of sedative and analgesic agents had obvious synergistic effects on enhancing sedation and analgesia as well as anti-muscle tension. Collectively, the combination of Dex and But could significantly benefit the prognosis of TBI.

摘要

目的

探讨右美托咪定(Dex)与布托啡诺(But)联合应用对创伤性脑损伤(TBI)患者的影响。

材料与方法

将 208 例 TBI 患者于 2018 年 2 月至 2020 年 1 月随机分为四组:对照组(A)、右美托咪定组(B)、布托啡诺组(C)和右美托咪定与布托啡诺联合组(D)。四组患者均给予相应的治疗及临床观察。对四组患者的生命体征、血氧饱和度、血清神经内分泌数据、疼痛、躁动评分等指标进行统计学分析。

结果

对四组患者的生命体征和血氧饱和度统计数据进行比较,发现 A 组和 D 组比较差异有统计学意义(p<0.05),提示低剂量镇静、镇痛药物联合应用可以改善 TBI 患者的生命体征,且安全性较好。术后第 5 天 D 组患者的格拉斯哥昏迷量表(GCS)评分较对照组(A 组)提高,提示镇静、镇痛药物联合应用可以改善患者的意识。联合组的神经内分泌数据波动较小,提示镇静、镇痛药物联合应用可以明显减轻应激反应。联合组患者在第 3 天和第 5 天的疼痛和躁动评分明显改善,提示联合组效果优于对照组。

结论

右美托咪定与布托啡诺联合应用治疗生命体征更稳定。与各单一组治疗相比,联合组患者改善迅速。从治疗到稳定的时间缩短,与对照组相比,预后明显更好。低剂量右美托咪定与布托啡诺联合应用可显著维持神经内分泌稳定。同时,镇静、镇痛药物联合应用对增强镇静、镇痛及抗肌紧张具有明显的协同作用。综上所述,右美托咪定与布托啡诺联合应用可明显改善 TBI 患者的预后。

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