Lu Shitao, Song Haiying, Lin Yuxin, Song Bo, Lin Sheng
Department of Emergency, Yantai Mountain Hospital Affiliated to Binzhou Medical College, Yantai, Shandong, 264000, China.
Department of Gynecology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, 264000, China.
Neurol Sci. 2025 Apr;46(4):1741-1750. doi: 10.1007/s10072-024-07916-8. Epub 2024 Dec 14.
The aim of this study is to assess the neuroprotective efficacy of early goal-directed sedation (EGDS) primarily governed by dexmedetomidine in patients experiencing severe traumatic brain injury, and to elucidate its potential underlying mechanisms.
All participants were randomly allocated into two groups: the experimental group-dexmedetomidine-dominated EGDS group (group D, n = 30) and the control group-the standard propofol sedation group (group P, n = 30). Patients in the experimental group received sedation primarily with dexmedetomidine, while those in the control group received propofol sedation. Subsequently, retrograde catheterization of the internal jugular vein on the affected side was performed, blood gas analysis samples were collected, cerebral oxygen extraction rates were computed, and levels of interleukin 6 (IL-6) and interleukin 1β (IL-1β) were assessed. One-way ANOVA and Chi-square tests were used for statistical analysis.
In group D, significant reductions were observed in the duration of ventilator dependency (p < 0.05).Compared to those documented in group P, tracheostomy incidence, and pulmonary infection rates were no different (p > 0.05). On the second, third and the seventh day, the SjvO2 levels in group D exhibited a statistically significant elevation compared to group P, while the CERO levels were notably lower in group D than in group P (p < 0.05). The GCS scores of patients in group D was significantly higher than that of the patients in group P and the baseline value on the seventh day and the time of discharge (p < 0.05). Additionally, the IL-6 levels in group D were significantly lower than those in group P and their corresponding baseline levels on the third and seventh days (p < 0.05). The IL-1β levels were no significant difference between the two groups.
A predominance of dexmedetomidine in EGDS demonstrates efficacy in reducing the duration of ICU stay and ventilator dependency, enhancing cerebral oxygen metabolism, and attenuating the infiltration of inflammatory factors.
本研究旨在评估以右美托咪定为主导的早期目标导向镇静（EGDS）对重度创伤性脑损伤患者的神经保护疗效，并阐明其潜在的作用机制。
所有参与者被随机分为两组：实验组——以右美托咪定为主导的EGDS组（D组，n = 30）和对照组——标准丙泊酚镇静组（P组，n = 30）。实验组患者主要接受右美托咪定镇静，而对照组患者接受丙泊酚镇静。随后，对患侧颈内静脉进行逆行置管，采集血气分析样本，计算脑氧摄取率，并评估白细胞介素6（IL-6）和白细胞介素1β（IL-1β）水平。采用单因素方差分析和卡方检验进行统计分析。
D组患者机械通气依赖时间显著缩短（p < 0.05）。与P组相比，气管切开发生率和肺部感染率无差异（p > 0.05）。在第2、3和7天，D组的颈静脉血氧饱和度（SjvO2）水平较P组有统计学显著升高，而D组的脑氧摄取率（CERO）水平显著低于P组（p < 0.05）。D组患者在第7天和出院时的格拉斯哥昏迷量表（GCS）评分显著高于P组患者及基线值（p < 0.05）。此外，在第3天和第7天，D组的IL-6水平显著低于P组及其相应基线水平（p < 0.05）。两组间IL-1β水平无显著差异。
在EGDS中以右美托咪定为主导可有效缩短重症监护病房（ICU）住院时间和机械通气依赖时间，增强脑氧代谢，并减轻炎症因子浸润。
