Clinical research of titration analgesia applying in severe traumatic brain injury in children
Objective:To investigate the value and feasibility of titration analgesia applying in severe traumatic brain injury in children.Methods:A total of 56 children patients with severe craniocerebral injury who were admitted to the pediatric intensive care unit(PICU).From January 2018 to January 2021 were included and randomly divided into titration analgesia group and routine analgesia group.There were 28 patients in per group.Titrated analgesia group:remifentanil 3 pg·kg-1·h-1 was used to start,and the dose was adjusted according to heart rate,invasive arterial pressure,cerebral blood flow,FLACC score(Child Pain Assessment FLACC Scale),etc.,so that the FLACC score was between 2～3 points,and the light analgesia state was maintained.The analgesia intensity was increased 24 h postoperative and before invasive procedures(such as sputum aspiration,puncture,etc.)to make FL ACC score between 0 and 1,and the light analgesia state was resumed after the operation.Routine analgesia group:remifentanil was started at 3 μg·kg-1·h-1,and the dosage was adjusted according to heart rate,invasive arterial pressure,cerebral blood flow,FLACC score,etc.,so that FLACC score was maintained between 0 and 1.All patients were sedated with midazolam 1-5 pg·kg-1·min-1,and maintained the RASS score between-2 and 0.All patients were received emergency surgery within 24 hours after admission,and were given comprehensive treatment(such as reducing intracranial pressure,hemostasis,maintaining blood pressure and mechanical ventilation etc)and adverse events were recorded in the two groups of heart rate,invasive arterial pressure,PCIS score,GCS score,duration of mechanical ventilation,the incidence of ventilator associated pneumonia(VAP),the incidence of adverse events and the total amount of analgesic and sedative drugs.Results:Among the 56 patients,patients who received titration analgesia therapy had recovering faster PCIS score and GCS score.And the recovery time of consciousness and the Mechanical ventilation time was relatively shorter.The incidence of VAP was lower.And had a Less total amount of analgesic and sedative drugs.The incidence of adverse events(bradycardia,hypotension,hypoxemia and accidental extubation rates)were no statistical differences.Conclusion:The titration analgesia strategy can make the heart rate and invasive arterial pressure more stable postoperative of Severe Brain Injury in Children,It is helpful to the postoperative vital signs and neurological recovery in children with severe brain injury,shorten mechanical ventilation and ICU time,and has a lower incidence of ventilator-related pneumonia(VAP).The method is safe and feasible.
NETL
NSTL
万方数据
维普
