Protective Effect Of Dexmedetomidine Hydrochloride Combined With Butorphanol Tartrate On Myocardium After Traumatic Brain Injury

BACKGROUND: Traumatic brain injury not only destroys the integrity and function of the brain,but also causes systemic multi-system injury and dysfunction,including cardiovascular dysfunction,through neuroendocrine and neuro-immune mechanisms.Secondary myocardial injury often occurs after traumatic brain injury,which in turn will further aggravate the occurrence of traumatic brain injury and other complications,leading to increased mortality.Therefore,effective prevention and protection of secondary myocardial injury after traumatic brain injury is very important and meaningful for the prognosis of those patients.Objective: To investigate the protective effect of dexmedetomidine hydrochloride combined with butorphanol tartrate on myocardium after traumatic brain injury,so as to provide clinical basis for the protection of secondary myocardial injury after traumatic brain injury.METHODS: A prospective study of 168 patients with traumatic brain injury admitted to intensive care unit(ICU)of Affiliated Hospital of Southwest Medical University from March 2016 to December 2018 was conducted.The patients were divided into four groups: midazolam group(n = 42),dexmedetomidine hydrochloride group(n = 42),butorphanol tartrate group(n = 42),dexmedetomidine hydrochloride combined with butorphanol tartrate group(n = 42).Finally,156 patients were included in midazolam group(n = 39),hydrochloric acid group.Dexmedetomidine group(n = 40),butorphanol tartrate group(n = 38),dexmedetomidine hydrochloride combined with butorphanol tartrate group(n = 39).Midazolam,dexmedetomidine hydrochloride,butorphanol tartrate and dexmedetomidine hydrochloride combined with butorphanol tartrate were used for sedation respectively.The changes of electrocardiogram,myocardial enzymes and cardiac function were observed after sedation in four groups,and the complications after treatment were observed.RESULTS:(1)No significant differences in age,sex,GCS score at admission,cause of injury,type of injury,time from injury to admission,and past medical history in the four groups,the general data were clinically comparable(P > 0.05).(2)There was no significant difference in ECG in the four groups(P > 0.05).Compared with midazolam group,ECG abnormalities in dexmedetomidine hydrochloride group and butorphanol tartrate group was decreased at 3th and 5th day after operation,and ECG abnormalities in dexmedetomidine hydrochloride combined with butorphanol tartrate group was decreased compared with other three groups(P < 0.05).(3)There was no significant difference in immediate cardiac function parameters in the four groups(P > 0.05).Compared with midazolam group,left ventricular ejection fraction(EF)and stroke output(SV)in dexmedetomidine hydrochloride and butorphanol tartrate group increased 3 and 5 days after operation;compared with the other three groups,the cardiac function of dexmedetomidine hydrochloride combined with butorphanol tartrate group increased.Left ventricular ejection fraction(EF)and stroke output(SV)increased in the parameters(P < 0.05).(4)There was no significant difference in the blood myocardial injury markers(cTnI,CK-MB)in the four groups(P > 0.05).Compared with midazolam group,the blood myocardial injury markers(cTnI,CK-MB)in dexmedetomidine hydrochloride group and butorphanol tartrate group showed a decreasing trend at 3th and 5th day after operation;compared with the other three groups,the blood of dexmedetomidine hydrochloride combined with butorphanol tartrate group showed a decreasing trend.The expression of myocardial injury markers(cTnI,CK-MB)was decreased(P < 0.05).(5)There was no significant difference in the mortality rate over one week between the four groups(P > 0.05).Compared with midazolam group,the mortality rate of the other three groups had a decreasing trend.Compared with the other three groups,the GCS score and GOS score of 28 days in dexmedetomidine hydrochloride combined with butorphanol tartrate group increased,and the days of ICU hospitalization,total hospitalization days,coma days,mechanical ventilation days increased.The number is reduced.CONCLUSION: Dexmedetomidine hydrochloride combined with butorphanol tartrate can reduce abnormal ECG,increase left ventricular ejection fraction(EF)and stroke output(SV)and decrease the expression of cardiac injury markers(cTnI,CK-MB)in patients with severe traumatic brain injury after operation,which can provide myocardial protection for secondary myocardial injury after traumatic brain injury and improve the prognosis of patients with severe traumatic brain injury.