Effect Of Dexmedetomidine On Postoperative Restlessness In Patients With Medium Craniocerebral Injury

Objective:The purpose of this study was to study the effect of intravenous infusion of dexmedetomidine on postoperative agitation complications and hemodynamics and the occurrence of postoperative adverse reactions in patients with moderate head injury,and to provide preliminary reference for clinical anesthetic use.Methods:A total of 40 patients with acute craniocerebral trauma who underwent craniotomy under general anesthesia were selected.Glasgow Grade(GCS)scored 9 to 12 on admission.Among them,there were 30 males and 10 females,aged 18 to 60 years old,with grades ASA I to II.All patients had transcranial brains.CT and/or MRI were diagnosed and randomly divided into two groups: dexmedetomidine in the experimental group(20 cases,group D,n=20),dexmedetomidine,1.0 ?g/kg(infusion time was not less than 10 min)Intravenous injection before induction of anesthesia,followed by 0.5?g/kg · h maintenance of the pump until the beginning of the cap suture;saline control group of 20 patients(C,n = 20),while the pump Note the same volume of saline.Anesthesia was induced with Midazolam(Lee Yuexi)0.1 mg/kg,Sufentanil 0.5 ?g/kg,Bensulfatracurium 0.2 mg/kg and Propofol 2 mg/kg,and pressure was applied to remove nitrogen.After 3 minutes of oxygen,the trachea was intubated orally and confirmed to be connected with the anesthesia machine to control ventilation,Tidal volume 8ml/kg,oxygen flow 1.5L/min,respiratory rate 12 times/min,inhalation ratio 1:2.Both groups used propofol 4 ~ 12mg/kg · h + triamcinolone,1.5?g/kg · min + remifentanil 0.05 ~ 2?g/kg · min,continuous intravenous infusion to maintain anesthesia;Breathing parameters were adjusted during the operation according to arterial blood gas test results,and maintain PETCO2 between 30~ 40 mmHg;According to the arterial blood pressure to adjust the anesthetic infusion rate,the arterial pressure fluctuations within 30% of the basic value.The muscle relaxants and dexmedetomidine stopped the infusion at the same time.At the end of the surgery,all anesthetic drugs were stopped.The patients were conscious and had extubation instructions and then removed the endotracheal tube.Observed indicators:(1)Record the time,awake time and extubation time of respiratory recovery in two groups;(2)record the awakening instant(T1),extubation instant(T2),extubation 5 min(T3),and HR and MAP at 30 minutes(T4),60 minutes(T5),and 120 minutes(T6),Riker sedation agitation score,Ramsay sedation score,and VAS pain score;(3)Record the extent and incidence of incitement;(4)Record The amount of remifentanil and propofol;(5)Record the occurrence of adverse reactions.Results:There was no significant difference in general data,postoperative respiratory recovery time,awakening time and extubation time between the two groups(P > 0.05);After 60 minutes of extubation,the HR and MAP at each time point in group C were significantly higher than those in group D,and the difference was statistically significant(P<0.05);The Riker sedation and agitation scores at each time point in group C were significantly higher than those in group D within 60 min after extubation.The difference was statistically significant(P<0.05);After 120 minutes of extubation,the degree and incidence of agitation in group C were significantly higher than those in group D,and the difference was statistically significant(P<0.05);The VAS scores at each time point in group C were significantly higher than those in group D within 60 minutes after the extubation.The difference was statistically significant(P<0.05);Ramsay at each time point within 60 minutes after extubation in group C.The sedation score was significantly lower than that of the D group(P<0.05).There was no significant difference between the two groups at 120 min after extubation(P>0.05);Remifentanil in group C The doses of propofol and propofol were significantly higher than those of group D,and the difference was statistically significant(P<0.05).The incidence of chills and snoring was significantly different between the two groups(P<0.05).Conclusion:Dexmedetomidine has a sedative and analgesic effect,which can effectively reduce the incidence of postoperative agitation in patients with moderate craniocerebral injury,and reduce the degree of restlessness,while reducing the use of remifentanil and propofol during surgery.It is helpful to maintain the stability of the circulation and less adverse reactions after surgery.