脑电双频指数联合丙泊酚闭环靶控输注在重症监护病房患者持续镇静中的应用

摘要

目的 探讨脑电双频指数(BIS)联合丙泊酚闭环靶控输注(CLTCI)在重症监护病房(ICU)患者持续镇静中的应用价值.方法 将70例实施机械通气并需持续镇静的ICU患者按镇静治疗方法不同分为观察组和对照组各35例.观察组采用BIS反馈控制下的丙泊酚CLTCI进行镇静,对照组采用丙泊酚常规输注进行镇静.记录镇静前5 min及镇静开始后5 min、30 min、1 h、6 h、12 h及24 h时2组的Ramsay评分、心率(HR)、平均动脉压(MAP)及观察组的BIS,分析BIS与Ramsay评分的相关性;比较2组的镇静效果.结果 BIS与Ramsay评分呈负相关(P<0.05);镇静前,2组的Ramsay评分、HR及MAP差异均无统计学意义(P>0.05);镇静后1 h开始2组HR、MAP均明显低于镇静前(P<0.05);2组间镇静前后MAP平均降低程度差异无统计学意义(P>0.05);观察组维持合理镇静时间百分比(76.7%)明显大于对照组(P<0.05).结论 BIS与Ramsay评分具有较好的相关性,可作为ICU机械通气患者镇静深度的评估指标.在BIS反馈控制下的丙泊酚CLTCI镇静方法对ICU患者的疗效较稳定,镇静效果较理想.%Objective To investigate the value of bispectral index (BIS) combined with propofol closed-loop target controlled infusion (CLTCI) in continuous sedation of patients in the intensive care unit (ICU).Methods Seventy ICU patients who underwent mechanical ventilation and needed continued sedation were divided into the observation group (n=35) and control group (n=35) according to their sedation methods.Patients in the observation group were given the sedation with propofol CLTCI under the control of BIS,while patients in the control group were given the sedation with conventional infusion.Before (5 min) and after (5 min,30 min,1 h,6 h,12 h and 24 h) of the sedation,we recorded the Ramsay score,heart rate (HR) and mean arterial pressure (MAP) in the two groups,as well as BIS in the observation group.The correlation between BIS and Ramsay score was analyzed,and the effects of sedation between the two groups were compared.Results BIS was negatively correlated with Ramsay score (P<0.05).Before sedation,there was no significant difference in Ramsay score,HR and MAP between the two groups (P>0.05).The HR and MAP in the two groups after sedation were significantly lower than that before sedation (P<0.05).However,no significant difference of the average reductions of HR and MAP were found between the two groups (P>0.05).Compared with the control group,the percentage of reasonable sedation time maintaining (76.7%) in the observation group was obviously more higher (P<0.05).Conclusion BIS has a good correlation with Ramsay score,and it can be used as an indicator for evaluating the depth of sedation in patients with ICU mechanical ventilation.The sedation method of BIS combined with CLTCI has stable and ideal sedative effects for ICU patients.