The Effect Of Different Sedative Schemes On Cerebral Hemodynamics And Prognosis For Patients With Severe Craniocerebral Injury

Objective: Brain injury is the main cause of disability and death.The causes of brain injury are cerebral apoplexy,intracranial infection,intracranial tumor and brain trauma.Brain injury includes direct injury of wound site and secondary injury caused by pathophysiological process such as stress reaction,ischemia and hypoxia,hypotension,hyperthermia,convulsion,infection and intracranial hypertension,which may sustain for several days or even a few months,therefore,brain damage is a progressive pathological process.In recent years,for the primary treatment of severe brain injury such as mechanical ventilation,maintaining stable circulation,correct anemia and hypoproteinemia,timely removal of intracranial lesions and brain functional diversification monitoring has become a global consensus,but the analgesic and sedative treatment but did not attract enough attention.In this study,we investigate the effect of different sedative scheme on cerebral blood flow in patients with severe craniocerebral injury and the prognosis of these different sedation,to provide a basis and reference for the clinical implementation of sedation in patients with severe craniocerebral injury.Methods: In the period from April2016 to January 2018,90 patients with severe craniocerebral injury were prospectively enrolled in this study at ICU of the Affiliated Hospital of Southwest Medical University,which were randomly divided into three groups,including midazolam group,propofol group and dexmedetomidine group,30 cases in each group respectively.The patients from three groups underwent taditional large trauma decompression and routine treatment.The patients from midazolam group were given intravenous infusion of midazolam,the patients from propofol group were given intravenous infusion of propofol and the patients from dexmedetomidine group were pumped intravenously with dexmedetomidine.The intracranial pressure(ICP),cerebral hemodynamic index,Glasgow Coma Scale(GCS),Glasgow outcome classification(GOS) and complications were observed and analyzed in all three groups.Results:According to inclusion criteria,exclusion criteria and exclusion criteria,27 patients in midazolam group,27 patients in propofol group and 28 patients in dexmedetomidine group were included.1.General information: age,gender,cause of injury,injury type and location,injury to admission time,past medical history and other aspects of the difference had no statistically significant in all three groups,whose general data has clinical comparability(P>0.05).2.No statistically difference of intracranial pressure(ICP)in patients in three groups before and 1d post-treatment(P>0.05);however,on 3d and 7d post-treatment,compared to midazolam group,propofol group and dexmedetomidine group ICP patients decreased obviously at different time points(P<0.05),compared with propofol group the patients in dexmedetomidine group ICP showed no significant difference(P>0.05).3.The cerebral hemodynamics pre-treatment and 1d post-treatment,with middle cerebral artery systolic blood flow velocity(Vs),the average blood flow velocity(Vm)and pulsatility index(PI)in all three groups showed no significant difference(P>0.05);however,on 3d and 7d post-treatment,middle cerebral artery systolic blood flow velocity(Vs),the average blood flow velocity(Vm),pulsatility index(PI)decreased in propofol group and the dexmedetomidine group compared to midazolam group at different time points(P<0.05);no significant difference in middle cerebral artery systolic blood flow velocity(Vs),the average blood flow velocity(Vm)and pulsatility index(PI)had in dexmedetomidine group compared with propofol group,(P>0.05).4.Glasgow coma score(GCS): there was no significant difference in GCS score in the three groups before treatment(P>0.05).After treatment,compared with midazolam group,GCS score in propofol group and dexmedetomidine group patients increased clearly(P<0.05),compared with propofol group,GCS score in dexmedetomidine group was statistically significant higher(P>0.05).5.Glasgow Outcome Scale(GOS):After treatment,compared with midazolam group,the patients in propofol group and dexmedetomidine group had higher Glasgow prognosis score(P<0.05),reduced mortality(P<0.05).There was no significant difference between propofol group and dexmedetomidine group(P > 0.05).6.Complication:there was no significant difference in the incidence of pulmonary infection,upper gastrointestinal bleeding,epilepsy and electrolyte disturbance in the three groups after treatment(P>0.05).Conclusions:The Propofol and dexmedetomidine sedation regimen can effectively improve intracranial pressure(ICP),cerebral hemodynamics and prognosis for the treatment of severe head injury,reduce the mortality and do not increase complications,which has a positive brain protective effect.