| Objective Dexmedetomidine is a relatively new sedative,its application in the Department of Neurosurgery lack of clinical evidences.This study aimed to study the efficacy of dexmedetomidine on sedation in patients with traumatic brain injury.Method 120 cases of of craniocerebral trauma patients from January 2014 to December 2015 in our department were selected as research subjects?In accordance with the random number table,the patients were randomly divided into dexmedetomidine group(n=60)and lytic cocktail group(n=60).There was no significant difference in age,sex ratio,body weight and GCS score between the two groups after statistical analysis.In dexmedetomidine group,dexmedetomidine load 0.5-1.0 ?g/kg was injected within 10 minutes,and maintaining at 0.2-0.7?g·kg-1·h-1 for 3 days.In lytic cocktail group,lytic cocktail was injected into muscle every 8 hours for 3 days.The factors of the two groups including age,gender,weight,GCS,vital signs(heart rate,mean arterial pressure,respiratory rate,blood oxygen saturation),C-reactive protein,adverse reaction,complication,length of stay,prognosis,were analyzed by statistical analysis.Result(1)In dexmedetomidine group,the data were age(36.2±10.8years),gender(male/female 38/22),weight(68.3±13.2kg),GCS score(10.8±3.2).Compared with the lytic cocktail group(34.6±11.2years,male/female 43/17,65.5±11.5kg,10.2±2.6),between group differences were insignificant(P > 0.05).(2)Compared with pre-treatment,In dexmedetomidine group the heart rate(72.4±7.8)and MAP(87.8±8.1mm Hg)had no difference,but in lytic cocktail group(HR66.2±7.6,MAP 87.8±8.1mm Hg)they all declined greatly.No marked changes were detected in blood oxygen saturation of the two groups,the data were 96.4±2.9,96.2±2.1.(3)C-reactive protein of dexmedetomidine group(32.8±7.1mg/L)and lytic cocktail group(41.2±7.9mg/L)increased and peaked in the 3rd day,but 1 day after admission the growth in dexmedetomidine group(28.5±6.2mg/L)were markedly lower than lytic cocktail group(34.8±7.2mg/L).(4)The incidence of adverse reaction and complication in dexmedetomidine group()were lower than lytic cocktail group.The numbers of bradycardia,hypotension,stress ulcer,pulmonary infection were 13,10,7,8 in dexmedetomidine group,compared with the numbers of 23,20,16,17 in lytic cocktail group.The date of light sedation group(3,2,1,1)were significantly lower than deep sedation group(10,8,6,7).(5)Length of ICU stay(12.8±5.5days)and total length of stay(21.2±6.5days)of dexmedetomidine group were obviously reduced.The data in lytic cocktail group were(15.3±6.1 days),(28.5±7.4 days).(6)At 6-month follow-up,the numbers of the patients scoring 1 to 5 according to Glasgow Outcome Scale were respectively 3,5,10,15,27 in dexmedetomidine group,while lytic cocktail group were respectively 5,9,13,16,17.The result of the dexmedetomidine group was better than that of the lytic cocktail group for GOS by Ridit analysis [ Ridit(Dexmedetomidine)=0.552,Ridit(lyticcocktail)=0.448,P=0.048].There was no significant difference in mortality between dexmedetomidine group and lytic cocktail group(5% vs.8.3%).Conclusion Dexmedetomidine is of satisfactory sedative effect for patients with traumatic brain injury.The effect is significant,and the patients can be wakened at any time.And the same time,it has no effects on respiratory system and circulatory system.Dexmedetomidine can obviously reduce CRP levels,inhibit inflammation response,shorten the length of stay and improve the prognosis of patients.it is suitable for sedation in patients with brain injury.Shallow sedation can reduce the incidence of adverse reactions and complications.In clinical work we should pay attention to monitoring the depth of sedation when applicating Dexmedetomidine,maintaining a relatively shallow state of sedation. |
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