Effects of sedation and analgesia on postoperative intracranial pressure in patients with severe traumatic brain injury

doi:10.3877/cma.j.issn.2095-9141.2018.05.006

Abstract

Abstract:

Objective

To investigate the effect of sedation and analgesia on intracranial pressure (ICP) in patients with severe and severest traumatic brain injury(TBI).

Methods

Forty-five patients with severe TBI admitted to Department of Neurosurgery of Huzhou First People’s Hospital from January 2016 to June 2018 were divided into severe TBI group (GCS scores 6-8, 26 cases) and severest TBI (GCS scores 3-5, 19 cases) according to GCS score. Observing ICP value fluctuations under sedative and analgesia or withdrawal of sedative and analgesia/awake.

Results

There was no significant difference in ICP between patients with severest TBI before and after sedation and analgesia (P>0.05). There was a significant difference in ICP changes before and after sedation and analgesia in patients with severe TBI(P<0.05).

Conclusion

Analgesia and sedation are significantly correlated with intracranial pressure fluctuations after craniotomy operation for severe TBI. In severe TBI group, safe and stable ICP can be obtained by controlling sedation and analgesia.

Key words: Severe traumatic brain injury, Severest traumatic brain injury, Sedation and analgesia, Intracranial pressure

Fan Xu, Lijuan Shen, Xingming Zhong. Effects of sedation and analgesia on postoperative intracranial pressure in patients with severe traumatic brain injury[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2018, 04(05): 276-278.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhsjcswkdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9141.2018.05.006

https://zhsjcswkdzzz.cma-cmc.com.cn/EN/Y2018/V04/I05/276

Figures/Tables 2

References 17

[1]	徐慧英，李爱萍.创伤性颅脑损伤的康复治疗进展[J].中国康复医学杂志, 2011, 26(5): 489-491.
[2]	Vincent JL, Berré J. Primer on medical management of severe Brain injury. Crit Care Med, 2005, 33(6): 1392-1399.
[3]	吴孟超，吴在德，吴汉,等.外科学[M].第8版.北京:人民卫生出版社, 2013: 188-189.
[4]	陈君，许秀娟.不同药物对ICU颅脑外伤患者的镇痛镇静作用[J].健康研究, 2016, 36(2): 159-161, 164.
[5]	刘宇，胡雪忠，徐伟华,等.右美托咪定在ICU重型颅脑外伤患者镇静中的应用[J].中国现代医生, 2013, 51(11): 83-84, 86.
[6]	中国医师协会神经外科医师分会神经重症专家委员会.重症脑损伤患者镇痛镇静治疗专家共识[J].中国脑血管病杂志, 2014, 11(1): 48-55.
[7]	Wunsch H, Kahn JM, Kramer AA, et al. Use of intravenous infusion sedation among mechanically ventilated patients in the United States[J]. Crit Care Med, 2009, 37(12): 3031-3039.
[8]	Hukkelhoven CW, Steyerberg EW, Farace E, et al. Regional differences in patient characteristics, case management, and outcomes in traumatic brain injury: experience from the tirilazad trials[J]. J Neurosurg, 2002, 97(3): 549-557.
[9]	Jacobi J, Fraser GL, Coursin DB, et al. Clinical practice guidelines for the sustained use of sedatives and analgesicsin the critically ill adult[J]. Crit Care Med, 2002, 30(1): 119-141.
[10]	中华医学会重症医学分会.中国重症加强医疗病房患者镇痛和镇静治疗指导意见(2006)[J].中华外科杂志, 2006, 44(17): 1158-1166.
[11]	Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit[J]. Crit Care Med, 2013, 41(1): 263-306.
[12]	Kato T, Koitabashi T, Ouchi T, et al. The utility of bispectral index monitoring for sedated patients treated with low-dose remifentanil[J]. 2012, 26(6): 459-463.
[13]	Vora TK, Karunakaran S, Kumar A, et al. Intracranial pressure monitoring in diffuse brain injury-why the developing world needs it more?[J]. Acta Neurochir (Wien), 2018, 160(6): 1291-1299.
[14]	De Bonis P, Anile C, Honeybul S. Intracranial-pressure monitoring in traumatic brain injury[J]. N Engl J Med, 2013, 368(18): 1749-1750.
[15]	夏婧，张玮，钱传云.镇静治疗对ICU危重患者应激的预防作用[J].临床麻醉学杂志, 2009, 25(1): 64-65.
[16]	Citerio G. Cormio M. Sedation in neurointensive care: advances in understanding and practice[J]. Curr Opin Crit Care, 2003, 9: 120-126.
[17]	韩敏，杜勇健，杨光诚.对重症颅脑创伤镇静镇痛的认识[J].中华神经创伤外科电子杂志, 2018, 4(1): 42-45.

组别	例数	年龄(岁)	性别
组别	例数	年龄(岁)	男	女
重型颅脑损伤	26	48.12±16.51	16	10
特重型颅脑损伤	19	44.47±19.11	11	8
t/χ²	?	2.017	0.038
P值	?	0.497	0.951

组别	例数	年龄(岁)	性别
组别	例数	年龄(岁)	男	女
重型颅脑损伤	26	48.12±16.51	16	10
特重型颅脑损伤	19	44.47±19.11	11	8
t/χ²	?	2.017	0.038
P值	?	0.497	0.951

组别	重型颅脑损伤组	特重型颅脑损伤组
镇静镇痛中	13.36±6.89	18.73±7.87
撤除镇静镇痛/唤醒	18.91±8.71	20.06±6.38
t值	2.009	2.028
P值	0.014	0.571

组别	重型颅脑损伤组	特重型颅脑损伤组
镇静镇痛中	13.36±6.89	18.73±7.87
撤除镇静镇痛/唤醒	18.91±8.71	20.06±6.38
t值	2.009	2.028
P值	0.014	0.571

Please choose a citation manager

Content to export