中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2012年
9期
4-7
,共4页
周颖%张学政%丁斌%谢于鹏%金旭如
週穎%張學政%丁斌%謝于鵬%金旭如
주영%장학정%정빈%사우붕%금욱여
靶控输注%机械通气%镇静%脑电双频指数
靶控輸註%機械通氣%鎮靜%腦電雙頻指數
파공수주%궤계통기%진정%뇌전쌍빈지수
Target controlled infusion%Mechanical ventilation%Sedation%Bispectral index
目的 探讨脑电双频指数(BIS)监测下靶控输注咪达唑仑和丙泊酚对机械通气患者镇静的可行性及临床疗效.方法 选择重症呼吸衰竭、神志清醒、需气管插管机械通气至少24h的患者80例,按随机数字表法分为常规输注丙泊酚组(A组)、BIS监测下靶控输注丙泊酚组(B组)、常规输注咪达唑仑组(C组)、BIS监测下靶控输注咪达唑仑组(D组),每组20例.分析B组和D组BIS与Ramsay评分的相关性,比较四组平均动脉压(MAP)和心率的变化.结果 B组和D组BIS与Ramsay评分均呈负相关(P＜0.05).四组在插管后24h时MAP均较插管成功即刻显著降低[A组:(63.89±4.68) mm Hg(1 mm Hg=0.133 kPa)比(92.33±3.57) mm Hg,B组:(62.66±3.97) mmHg比(93.76±4.02) mm Hg,C组:(64.59±3.29) mm Hg比(93.78±4.61) mm Hg,D组:(63.18±2.51)mm Hg比(93.61±5.36)mmHg],差异有统计学意义(P＜0.05),而且A组和B组在插管后1h时即达到此标准；四组在插管后24h时心率也有所下降,但差异无统计学意义(P＞0.05).结论 机械通气患者在BIS监测下靶控输注咪达唑仑和丙泊酚都能达到相近的镇静效果,但对于需要快速镇静的机械通气患者适宜选用丙泊酚.而且,BIS与Ramsay评分呈负相关.
目的 探討腦電雙頻指數(BIS)鑑測下靶控輸註咪達唑崙和丙泊酚對機械通氣患者鎮靜的可行性及臨床療效.方法 選擇重癥呼吸衰竭、神誌清醒、需氣管插管機械通氣至少24h的患者80例,按隨機數字錶法分為常規輸註丙泊酚組(A組)、BIS鑑測下靶控輸註丙泊酚組(B組)、常規輸註咪達唑崙組(C組)、BIS鑑測下靶控輸註咪達唑崙組(D組),每組20例.分析B組和D組BIS與Ramsay評分的相關性,比較四組平均動脈壓(MAP)和心率的變化.結果 B組和D組BIS與Ramsay評分均呈負相關(P＜0.05).四組在插管後24h時MAP均較插管成功即刻顯著降低[A組:(63.89±4.68) mm Hg(1 mm Hg=0.133 kPa)比(92.33±3.57) mm Hg,B組:(62.66±3.97) mmHg比(93.76±4.02) mm Hg,C組:(64.59±3.29) mm Hg比(93.78±4.61) mm Hg,D組:(63.18±2.51)mm Hg比(93.61±5.36)mmHg],差異有統計學意義(P＜0.05),而且A組和B組在插管後1h時即達到此標準；四組在插管後24h時心率也有所下降,但差異無統計學意義(P＞0.05).結論 機械通氣患者在BIS鑑測下靶控輸註咪達唑崙和丙泊酚都能達到相近的鎮靜效果,但對于需要快速鎮靜的機械通氣患者適宜選用丙泊酚.而且,BIS與Ramsay評分呈負相關.
목적 탐토뇌전쌍빈지수(BIS)감측하파공수주미체서륜화병박분대궤계통기환자진정적가행성급림상료효.방법 선택중증호흡쇠갈、신지청성、수기관삽관궤계통기지소24h적환자80례,안수궤수자표법분위상규수주병박분조(A조)、BIS감측하파공수주병박분조(B조)、상규수주미체서륜조(C조)、BIS감측하파공수주미체서륜조(D조),매조20례.분석B조화D조BIS여Ramsay평분적상관성,비교사조평균동맥압(MAP)화심솔적변화.결과 B조화D조BIS여Ramsay평분균정부상관(P＜0.05).사조재삽관후24h시MAP균교삽관성공즉각현저강저[A조:(63.89±4.68) mm Hg(1 mm Hg=0.133 kPa)비(92.33±3.57) mm Hg,B조:(62.66±3.97) mmHg비(93.76±4.02) mm Hg,C조:(64.59±3.29) mm Hg비(93.78±4.61) mm Hg,D조:(63.18±2.51)mm Hg비(93.61±5.36)mmHg],차이유통계학의의(P＜0.05),이차A조화B조재삽관후1h시즉체도차표준；사조재삽관후24h시심솔야유소하강,단차이무통계학의의(P＞0.05).결론 궤계통기환자재BIS감측하파공수주미체서륜화병박분도능체도상근적진정효과,단대우수요쾌속진정적궤계통기환자괄의선용병박분.이차,BIS여Ramsay평분정부상관.
Objective To investigate the feasibility and clinical effect of bispectral index (BIS) monitoring target controlled infusion of midazolam and propofol for sedation of mechanically ventilated patients.Methods Eighty cases with severe respiratory failure,sane,the need for endotracheal intubation mechanical ventilation for at least 24 h were divided into 4 groups by random digits table with 20 cases each.Group A and group C patients routinely received propofol and midazolam,group B and group D patients used BIS monitoring target controlled infusion of propofol and midazolam.The correlation of BIS and Ramsay score was analyzed,and the changes of mean arterial pressure (MAP) and heart rate (HR) were compared among 4 groups.Results BIS was negatively correlated with Ramsay score in group B and group D (P ＜ 0.05).MAP after 24 h intubation was lower than that at intubation immediately among 4 groups [group A:(63.89 ±4.68) mm Hg (1 mm Hg =0.133 kPa) vs.(92.33 ±3.57) mm Hg,group B:(62.66 ±3.97) mm Hg vs.(93.76 ± 4.02) mm Hg,group C:(64.59 ± 3.29) mm Hg vs. (93.78 ± 4.61 ) mm Hg,group D:(63.18 ±2.51 )mm Hg vs. (93.61 ± 5.36) mm Hg],and there were significant differences (P＜ 0.05).Group A and group B reached the standard after 1 h intubation.HR after 24 h intubation decreased in 4 groups,but there was no significant difference (P ＞ 0.05).Conclusions BIS monitoring target conmolled infusion of midazolam and propofol for sedation of mechanically ventilated patients can achieve similar sedative effects,in addition,the need for rapid sedation of mechanically ventilated patients with suitable choice of propofol.At the same time,BIS is negatively correlated with Ramsay score.
