| Objective: It’s an important element to concern that the neurological functions shall be recovered as soon as possible in the surgical treatment on traumatic brain injury. As a new generation of opioid receptor antagonist for neuroprotection therapy, nalmefene hydrochloride injection has been widely used in postoperative treatment of such diseases. Nalmefene hydrochloride injection is used with small doses at the beginning of anesthesia recovery and nalmefene is used in postoperative treatment persistently. By the comparison of vital signs, breathing recovery time, respiratory rate, extubation time,neuron-specific enolase( NSE), GCS scores and intracranial pressure(ICP)between nalmefene group and control group, the clinical efficacy on early application of nalmefene hydrochloride injection in moderate traumatic brain injuries can be analyzed.Methods: 40 patients who were diagnosed with moderate brain injuries in the PLA 251 hospital and need to receive emergency surgeries were selected(without severe associated injuries or vital organ function failures and getting treatments in the hospital within 6 hours after the injuries timely).They were divided Randomly into two groups, 20 patients in the nalmefene group while 20 patients in the control group. All patients were monitored with the blood pressure, the oxygen saturation and the ECG in the operating room.Warming blankets were used to keep the thermostat of the operating tables at 37 degrees C. The patients who had cardiovascular disease were taken non-invasive blood pressure monitoring and all patients were implemented the right subclavian vein puncture after stable induction of anesthesia. Nalmefene group and the control group were given midazolam0.05mg﹒kg-1,Sufentanil 0.3μg kg-1,Etomidate intralipid 0.15mg· kg-1 and Rocuronium 0.6mg· kg-1 to induce, then given the tracheal intubation in the wireless video laryngoscope. Intraoperative anesthesia was maintained with propofol continuous infusion of fat emulsion 2-4mg·kg-1·h-1, sufentanil injection 0.1-0.3μg·kg-1·h-1 infusion, meanwhile, bolu rocuronium was given to maintain muscle relaxants intermittently(stopping giving 40 minutes before the end of the surgery). According to the changes in the patient’s circulation signs and BIS monitoring, the amount of the drug was adjusted to maintain BIS value between 40-60 and relative stable of the hemodynamics. The mechanical ventilation oxygen flow was kept 1.5L· min-1, the regulate breathing frequency was kept 10 to 14 beats / minute and the tidal volume was kept 7 ~ 10ml·kg-1, PETCO2 was maintained 35 ~ 45 mmHg, 0.5mg atropine and 1mg neostigmine was injected by intravenous when the skin was sewn in the surgical procedure. SPO2 was maintained more than 90% in deoxy case after breathing recovery and then the patients were escorted with tracheal cannula oxygen back to neurosurgery intensive care unit.After the surgery, The two groups of patients were treated with traditional conventional therapy, and their bodies were supported by anti-inflammatory,dehydration and nutritional. The nalmefene group were given nalmefene hydrochloride injection 0.25μg· kg-1 at the end of the waking with slow intravenous infusion for 30 s, and 5min later they got the medicine repeatedly until their breathing restored to 10 beats / min.What is more, the total amount cannot be more than 1μg· kg-1. From the first day after the surgery,nalmefene hydrochloride 8μg· kg-1· d-1 was injected by intravenous for 10 days. The control group were given the same volume of placebo in anesthesia and postoperative period.Outcome measures:①Before anesthesia breathing recovery period(T0), after breathing recovery(T1) of MAP(mmHg), HR(beats / min), breathing recovery time(min), respiratory rate(beats / min), the pulse-deoxy case oxygen saturation(SPO2), extubation time(h).② Before anesthesia(T0), postoperative first day(T1), postoperative third day(T2), postoperative 7th day(T3), postoperative 14 th day(T4), venous blood of neuron-specific enolase( NSE) levels.③ The GCS scores before surgery(T0) and postoperative 2 weeks(T1).④ The intracranial pressure(ICP) of the postoperative first day(T0),postoperative third days(T1).⑤ The MAP(mmHg), HR(beats / min), RR(beats / min) before surgery(T0), in the postoperative first day(T1), postoperative 7th day(T2) and postoperative 14 th day(T3).All test data have been analyzed by SPSS13.0 statistical software and the normal distribution count data have been described by mean ± standard deviation(± S). All the data haven analyzed by using T test, where P <0.05 is considered significant difference.Results: Comparing the MAP(mmHg) and HR(beats / min) each time point between the two groups, there is no difference(P> 0.05). After the application of anesthesia, the nalmefene group’s breathing recovery time is shorter(P <0.01). Comparing the respiratory rate and SPO2(%) after breathing recovery, the rate of the nalmefene group is higher(P <0.01),their extubation time is shorter(P <0.05). When compare the content of NSE results for each time point between the nalmefene group and the treatment group, the difference is statistically significant(P <0.05). Wherein the nalmefene group’s result after 14 days decreased compared to that before surgery, the difference was statistically significant(P <0.05). Comparing the results three days after surgery, the ICP of the nalmefene group is lower than that of the control group, so the difference was statistically significant(P<0.01).Comparing the result of GCS score before surgery and 14 days after surgery, the differences of nalmefene group and the treatment group were not statistically significant(P> 0.05).Conclusion: The results show that injecting nalmefene hydrochloride to patients with moderate brain injury in anesthesia recovery period in small doses can reverse the respiratory depression induced by opioid narcotic analgesic drug effectively. Continued application of nalmefene hydrochloride injection after surgery can alleviate brain edema, reduce intracranial pressure and play a good cerebral protection. |
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