Zaštitno dejstvo deksmedetomidina u kombinaciji sa remifentanilom na perioperativno moždano tkivo kod pacijenata sa teškom traumatskom povredom mozga i uticaj na markere inflamacije u serumu
Sažetak
Uvod/Cilj. Pacijente sa teškom traumatskom povredom mozga (TBI) treba intenzivno pratiti i lečiti zbog značajne traume mozga odnosno drugih pratećih uzroka, kao što su komorbiditeti ili politrauma. Pacijenti sa takvim povredama su pod intenzivnim stresom, što dovodi do povećane ekscitabilnosti simpatikusa i čestog doživljaja uznemirenosti i bola. Odgovarajuća sedacija i analgezija ključne su za te pacijente jer mogu smanjiti komplikacije, mortalitet, posledice i poboljšati kvalitet života. Cilj rada bio je da se ispita uticaj deksmedetomidina u kombinaciji sa remifentanilom na postoperativnu sedaciju, analgeziju i cerebralni metabolizam kiseonika kod pacijenata sa TBI. Metode. Prospektivnom, jednostruko slepom, randomizovanom kontrolisanom kliničkom studijom obuhvaćeno je 80 bolesnika, podeljenih u dve grupe: kontrolnu grupu (KG) koja je primala deksmedetomidin (n = 40) i ispitivanu grupu (IG) koja je primala deksmedetomidin u kombinaciji sa remifentanilom (n = 40). Rezultati. U poređenju sa KG, IG je pokazala bolju sedaciju i analgeziju, skraćeno trajanje sedacije i mehaničke ventilacije, kao i sporiji srčani ritam, niži srednji arterijski pritisak i frekvenciju disanja. Takođe, u IG je utvrđeno statistički značajnije sniženje nivoa inflamacijskih markera i nivoa kortizola u serumu, kao i viši nivo β-endorfina. Takođe, indeksi cerebralnog metabolizma kiseonika su pokazali veće postoperativno poboljšanje u IG, mada razlika nije bila statistički značajna. Zaključak. Strategija sedacije i upravljanja bolom korišćenjem deksmedetomidina u kombinaciji sa remifentanilom poboljšava ishode lečenja pacijenata tako što ubrzava oporavak i smanjuje fiziološki stres. Potrebna su dodatna istraživanja da bi se utvrdili dugoročni efekti ove kombinacije na metabolizam kiseonika u mozgu.
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