瑞马唑仑复合右美托咪定镇静对老年创伤性颅脑损伤患者疗效相关指标的影响

doi:10.19854/j.cnki.1008-2425.2022.04.0009

摘要/Abstract

摘要： 目的研究瑞马唑仑联合右美托咪定镇静对老年创伤性颅脑损伤患者疗效相关指标以及血清神经元PAS结构与蛋白4(neuronal PAS structure and protein 4,NPAS4)和神经调节蛋白-1(NRG-1)的影响。方法选择2020年1月到2021年5月到我院进行治疗的老年创伤性颅脑损伤患者120例,依据随机数字法将患者随机分为3组,盐酸右美托咪定组、瑞马唑仑组和联合组。盐酸右美托咪定组患者在常规治疗基础上应用盐酸右美托咪定;瑞马唑仑组患者在常规治疗基础上给予瑞马唑仑;联合组患者在常规治疗基础上,进行盐酸右美托咪定和瑞马唑仑联合治疗。对患者治疗前后血流动力学指标(心率和平均动脉压(mean arterial pressure,MAP))、炎症介质(白细胞介素-6(IL-6)和C反应蛋白(CRP))和NGR-1、NPAS4水平进行检测。结果治疗1天和3天后,患者的心率和MAP均有所降低(P＜0.05),治疗后盐酸右美托咪定组和瑞马唑仑组患者的心率和MAP水平相似(P＞0.05),但是联合组患者的MAP和心率较其它两组下降更明显(P＜0.05);治疗1天和3天后,两组患者的IL-6和CRP均较治疗前有所降低(P＜0.05),治疗1天和3天后,盐酸右美托咪定组和瑞马唑仑组两组患者的CRP和IL-6水平相似(P＞0.05),但是联合组患者的IL-6和CRP水平均低于A、瑞马唑仑组(P＜0.05);治疗1天和3天后,三组患者的的NPAS4和NGR-1水平均较治疗前有所降低(P＜0.05),治疗1天和3天后,盐酸右美托咪定组和瑞马唑仑组患者NPAS4和NGR-1水平相似,但是联合组患者的NPAS4和NGR-1水平低于其余两组(P＜0.05)。结论瑞马唑仑联合右美托咪定能够改善患者的血流动力学和炎症介质水平,降低患者NGR-1、NPAS4表达,有一定的临床应用价值。

关键词: 瑞马唑仑, 右美托咪定, 老年创伤性损伤, 神经元PAS结构与蛋白4, 神经调节蛋白-1

Abstract: Objective To evaluate effect of remazolam combined with dexmedetomidine sedation regimen on effect-related indicators,neuronal PAS structure and protein 4 (NPAS4) and neuregulin-1 (NRG-1) of serum neurons in patients elderly patients with traumatic brain injury. Methods 120 elderly patients with traumatic brain injury who came to our hospital for treatment from January 2020 to May 2021 were selected.According to the random number method,the patients were randomly divided into 3 groups,group A,group B and group C.Patients in group A were treated with dexmedetomidine hydrochloride on the basis of conventional treatment; patients in group B were treated with remazolam on the basis of conventional treatment; patients in group C were treated with dexmedetomidine hydrochloride and remazol on the basis of conventional treatment Lun combination therapy.Hemodynamic indicators (heart rate and mean arterial pressure (MAP)),inflammatory mediators (interleukin-6 (IL-6) and C-reactive protein (CRP)) and NGR-1,NPAS4 level is tested.Results After 1 day and 3 days of treatment,the patient's heart rate and MAP decreased (P＜0.05).After treatment,the heart rate and MAP level of patients in group A and B were similar (P＞0.05),but patients in group C Compared with the other two groups,the MAP and heart rate decreased more significantly (P＜0.05); after 1 day and 3 days of treatment,the IL-6 and CRP of the two groups were lower than before treatment (P＜0.05),treatment 1 Days and 3 days later,the levels of CRP and IL-6 in group A and group B were similar (P＞0.05),but the levels of IL-6 and CRP in group C were lower than those in groups A and B (P＜0.05) ; After 1 day and 3 days of treatment,the levels of NPAS4 and NGR-1 of the three groups of patients were lower than before treatment (P＜0.05).After 1 day and 3 days of treatment,the NPAS4 of group A and group B patients The level was similar to NGR-1,but the levels of NPAS4 and NGR-1 in group C were lower than those in the other two groups (P＜0.05).Conclusion Remazolam combined with dexmedetomidine can improve the patient's hemodynamics and inflammatory mediator levels,and reduce the expression of NGR-1 and NPAS4 in patients,which has certain clinical application value.

Key words: Remazolam, Dexmedetomidine, Senile traumatic injury, Neuronal PAS structure and protein 4, Neuromodulin-1

中图分类号:

R651

姚艳粉，李丕宝，孙玮，葛均克. 瑞马唑仑复合右美托咪定镇静对老年创伤性颅脑损伤患者疗效相关指标的影响[J]. 立体定向和功能性神经外科杂志, 2022, 35(4): 235-240.

Yao Yanfen,Li Pibao,Sun Wei,et al.. Effects of Mazolam combined with dexmedetomidine sedation on curative effect-related indicators in elderly patients with traumatic brain injury[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2022, 35(4): 235-240.

参考文献

[1] Hor YK,Alex J,Wong KY,et al.Adult traumatic head injury:compliance with NICE guideline for CT head scan[J].Clinical Radiology,2020,75:e11.
[2] Petranovich CL,Smith-Paine J,Wade SL,et al.From Early Childhood to Adolescence:Lessons About Traumatic Brain Injury From the Ohio Head Injury Outcomes Study[J].Journal of Head Trauma Rehabilitation,2020,35(3):226~239.
[3] Kochar A,Borland ML,Phillips N,et al.Association of clinically important traumatic brain injury and Glasgow Coma Scale scores in children with head injury[J].Emergency Medicine Journal,2020,37(3):127~134.
[4] 孟祥婷,张弛,张励才.右美托咪定对单侧乳癌改良根治术患者麻醉苏醒期躁动和术后疼痛的影响[J].现代肿瘤医学,2019,27(17):3121~3124.
[5] 张蓉,赵泽宇,王馨雪,等.瑞马唑仑复合小剂量丙泊酚用于麻醉诱导时镇静的效果[J].中华麻醉学杂志,2021,41(7):820~822.
[6] 叶冲冲,谢永鹏,骆继业,等.不同剂量瑞马唑仑在ICU机械通气患者中的镇静效果及对血流动力学的影响[J].中国医药导报,2021,18(22):121~124.
[7] Fehily B,Bartlett C A,Lydiard S,et al.Differential responses to increasing numbers of mild traumatic brain injury in a rodent closed‐head injury model[J].Journal of Neurochemistry,2019,149(5):660~678.
[8] Niele N,Houten MV,Tromp E,et al.Application of PECARN rules would significantly decrease CT rates in a Dutch cohort of children with minor traumatic head injuries[J].European Journal of Pediatrics,2020,179(10):1~6.
[9] Clausen AN,Clarke E,Phillips RD,et al.Combat exposure,posttraumatic stress disorder,and head injuries differentially relate to alterations in cortical thickness in military Veterans[J].Neuropsychopharmacology,2019,45(3):491~498.
[10]栾樱译,姚咏明.创伤性脑损伤研究新进展[J].国际外科学杂志,2021,48(1):27~31.
[11]顾宇丹,费雅雅,秦殊,等.刺激性干预在老年创伤性颅脑损伤昏迷患者中的应用[J].中华护理杂志,2020,55(2):228~231.
[12]姜梦露,毛一帆,田玥.右美托咪定对老年股骨颈骨折患者麻醉安全性的影响[J].国际老年医学杂志,2019,40(4):211~213.
[13]罗凯,符黄德,姚洁民.瑞马唑仑临床应用的研究进展[J].中华重症医学电子杂志,2021,7(1):71~75.
[14]冯爱敏,乔迎帅,卢锡华,等.甲苯磺酸瑞马唑仑抑制老年患者气管插管心血管反应的有效剂量[J].国际麻醉学与复苏杂志,2021,42(8):800~802.
[15]史媛,蒋毅,董贝贝,等.瑞马唑仑和咪达唑仑对健康老龄大鼠认知功能影响的比较[J].中华麻醉学杂志,2020,40(9):1089~1092.
[16]渠明翠,张彤彤,邢飞,等.瑞马唑仑-阿芬太尼-米库氯铵用于纤维支气管镜检查术的效果[J].中华麻醉学杂志,2021,41(5):563~566.
[17]陈瑜,蔡姝,朱晓刚,等.瑞马唑仑用于老年患者全麻诱导时的镇静效果[J].中华麻醉学杂志,2020,40(8):974~976.
[18]谌雅雨,谈晓露,张兴安.靶控输注与恒速输注丙泊酚复合瑞芬太尼全凭静脉麻醉效果和安全性对比的系统评价[J].循证医学,2019,019(1):47~55.
[19]Ropelle ER,Flores MB,Cintra DE,et al.IL-6 and IL-10 Anti-Inflammatory Activity Links Exercise to Hypothalamic Insulin and Leptin Sensitivity through IKKβ and ER Stress Inhibition[J].Plos Biology,2019,8(8):697~704.
[20]邱德亮,刘星,赵松波,等.右美托咪定对大鼠不同时间脑缺血再灌注损伤保护作用[J].基因组学与应用生物学,2019,38(12):5726~5731.
[21]牛悦峰,常钧.监测麻醉应用咪达唑仑与右美托咪定的效果比较[J].山西医药杂志,2019,48(14):1729~1730.
[22]Lv H,Li Y,Cheng Q,et al.Neuroprotective Effects Against Cerebral Ischemic Injury Exerted by Dexmedetomidine via the HDAC5/NPAS4/MDM2/PSD-95 Axis[J].Molecular Neurobiology,2021,58(5):1990~2004.
[23]梁钰(综述),李顺昌(审校).NRG1-ErbB信号通路的生物学功能及其在各种疾病中的作用[J].海南医学,2021,32(19):2546~2550.
[24]West AE .Activity-Dependent Transcription Collaborates with Local Dendritic Translation to Encode Stimulus-Specificity in the Genome Binding of NPAS4[J].Neuron,2019,104(4):634~636.