Stewart L, Bullock R, Rafferty C, Fitch W, Teasdale G M
Department of Neurosurgery, Southern General Hospital, Glasgow, U.K.
Acta Neurochir Suppl (Wien). 1994;60:544-6. doi: 10.1007/978-3-7091-9334-1_150.
We have compared the effects of an intravenous infusion of propofol with those of morphine and midazolam on global brain metabolism (AVDO2) and brain perfusion following severe head injury. Fifteen patients were sedated with either a continuous infusion of propofol (mean rate 232 mg/h, range 150-400 mg/h) or infusions of morphine (mean rate 2.3 mg/h, range 0-4 mg/h) and midazolam (mean rate 2.8 mg/h, range 0-5 mg/h). Both groups were well matched for sex, age and level of coma (Glasgow coma scale) prior to sedation. Continuous data collection of AVDO2, mean arterial blood pressure (MABP), intracranial pressure (ICP), and cerebral perfusion pressure (CPP) began at 12 hours post injury and continued for a mean period of 40 hours. Morphine and midazolam did not have a significant effect on any of the measured parameters. Propofol led to a fall in AVDO2 from 6.0 +/- 2.6 ml/dl to 3.0 +/- 0.6 ml/dl at 4 hours. However, there was no effect on MABP, ICP or CPP. Outcome was similar in the 2 groups.
我们比较了静脉输注丙泊酚与吗啡和咪达唑仑对重度颅脑损伤后全脑代谢（AVDO2）和脑灌注的影响。15例患者分别接受持续输注丙泊酚（平均速率232mg/h，范围150 - 400mg/h）或输注吗啡（平均速率2.3mg/h，范围0 - 4mg/h）和咪达唑仑（平均速率2.8mg/h，范围0 - 5mg/h）进行镇静。两组在镇静前的性别、年龄和昏迷程度（格拉斯哥昏迷量表）方面匹配良好。在受伤后12小时开始连续收集AVDO2、平均动脉血压（MABP）、颅内压（ICP）和脑灌注压（CPP）的数据，并持续平均40小时。吗啡和咪达唑仑对任何测量参数均无显著影响。丙泊酚在4小时时使AVDO2从6.0±2.6ml/dl降至3.0±0.6ml/dl。然而，对MABP、ICP或CPP没有影响。两组的结局相似。
