Clinical efficacy of short-term deep sedation after decompressive craniectomy with hematoma removal in patients with hypertensive intracerebral hemorrhage / 中国基层医药

ABSTRACT

Objective:To investigate the efficacy and safety of short-term deep sedation after conventional decompressive craniotomy with hematoma removal in patients with hypertensive intracerebral hemorrhage.Methods:Sixty patients with hypertensive intracerebral hemorrhage who underwent conventional decompressive craniotomy with hematoma removal in the People′s Hospital of Yueqing, China between March 2018 and May 2019 were included in this study. They were randomly divided into deep sedation and light sedation groups ( n = 30/group). The deep sedation group was administered propofol (0.6-1.2 mg/kg/h) combined with sedate fentanyl to achieve the level of sedation to Richmond Agitation-Sedation Scale (RASS) -3 to -4 points and to the level of pain to Critical Care Pain Observation Tool (CPOT) 0-1 point. The duration of sedation and analgesia was for 48 hours. The light sedation group was administered propofol (0.2-0.5 mg/kg/h) combined with sedate fentanyl to achieve the level of sedation to RASS -1 to -2 points and to the level of pain to CPOT 0-1 point. The duration of sedation and analgesia was rehemorrhage for 48 hours. Patients in the two groups were intravenously administered Urapidil to control blood pressure to be 120-160/60-90 mmHg. In addition, all patients were subjected to mechanical ventilation, dehydration, reduction of intracranial pressure, anti-infection and symptomatic treatment. At 0, 6, 12, 24 and 48 hours after surgery, heart rate, mean arterial pressure, intracranial pressure, recurrence of hemorrhage, ventilator-associated pneumonia, lower extremity deep venous thrombosis, and gastrointestinal bleeding were monitored. Results:At 6, 12, 24 and 48 hours after surgery, the heart rate, mean arterial pressure, and intracranial pressure in the deep sedation group were significantly lower than those in the light sedation group ( P < 0.05 or P < 0.01). The recurrence of rehemorrhage and the incidence of gastrointestinal bleeding in the deep sedation group were 3.33% (1/30) and 6.67% (2/30), respectively, which were significantly lower than those in the light sedation group [10.00% (3/30), 20.00% (6/30), χ2 = 1.071, 2.307, both P < 0.05). There were no significant incidences in ventilator-associated pneumonia [30.00% (9/30) vs. 23.30% (7/30), χ2 = 0.340, P > 0.05] and lower extremity deep venous thrombosis [10.00% (3/30) vs. 6.67% (2/30), χ2 = 0.340, P > 0.05]. Conclusion:Short-term deep sedation after conventional decompressive craniotomy with hematoma removal can lower the heart beat, mean arterial pressure, intracranial pressure, the postoperative recurrence of hemorrhage, and the incidence of gastrointestinal bleeding in patients with hypertensive cerebral hemorrhage.