頭部外傷データバンク【プロジェクト2009】における重症頭部外傷患者の集中治療：積極的体温管理下における鎮静鎮痛管理の検討

抄録

The importance of temperature management has been advocated for critically ill intensive care patients suffering from a variety of conditions. Aggressive normothermia therapy (ANT) has recently been employed in severe head trauma management, but there are few reports on the administration of sedatives and analgesics as a part of intensive care management in the acute phase.

Purpose: To assess the particulars of intensive care management in patients with severe head injury registered in the Japan Neurotrauma Databank Project 2009 (JNTDB P2009), we retrospectively examined the use of muscle relaxants (i.e., neuromuscular blocking drugs [NMBDs]), sedative drugs, and analgesics.

Results: Of 1091 severe head trauma patients registered in the JNTDB P2009 from July 2009 to June 2011, 81 cases were excluded due to incomplete data collection, leaving 1010 cases that met the inclusion criteria in this study. Sedative drugs and analgesics tended to be avoided in higher Injury Severity Score and older cases. Drug intervention was employed in diffuse brain injury and evacuated mass lesion in younger cases. The percentage of NMBD use was significantly higher in younger cases. Thirty-four percent of patients received therapeutic temperature man­agement, 24% of which underwent ANT (deep temperature, 35 – 37˚C) and 10% of which underwent mild hypo­thermia therapy (deep temperature, 33 – 35˚C). The remaining 66% of patients received no temperature intervention (None group). Seventy-eight percent of the None group, 40% of the ANT group, and 7% of the HT group received no drug intervention. In terms of the sedative drugs, Propofol was used in 61% of the None group and 52% of the ANT group; Midazolam was used in 49% of the HT group. Since targeted temperature management is now commonly included in intensive care treatment, the development of pathophysiology-appropriate sedation protocols is essential.