CAJ | 학술논문

目的：利用BIS监测仪反馈控制闭环靶控输注系统进行异丙酚镇静，研究在不同BIS值反馈控制镇静程度下，颅脑创伤患者细胞代谢生化指标的变化，试图寻找对脑创伤患者最适宜镇静治疗的BIS值。方法对60例入住我医院EICU的颅脑损伤的患者随机分成四组（每组15例）。其中三组采用不同的BIS值（Ⅰ组55～65，Ⅱ组65～75，Ⅲ组75～85）作为反馈控制条件，闭环靶控输注异丙酚实施镇静；第Ⅳ组根据患者情况采用普通微量泵输注异丙酚进行镇静作为对照。在镇静治疗开始后第1h、以后的每8h收集患者的脑微透析液，收集时间为48h。收集出血灶周围水中带脑组织透析液用微透析仪测定葡萄糖（ Glu）、乳酸（ Lac）和甘油（ Gly）浓度。结果四组患者的Glu、Lac及Gly水平变化在组间两两比较的SLD－t检验中，结果存在明显差异（P＜0．001）。结论采用BIS值反馈控制闭环靶控输注系统输注异丙酚进行颅脑创伤患者的镇静，对颅脑创伤患者神经细胞代谢指标有不同影响，BIS值为55～65时有较好的脑保护作用，但当BIS值控制在55～65是否即镇静治疗最理想的BIS值，其副作用如何值得进一步研究。
목적：이용BIS감측의반궤공제폐배파공수주계통진행이병분진정，연구재불동BIS치반궤공제진정정도하，로뇌창상환자세포대사생화지표적변화，시도심조대뇌창상환자최괄의진정치료적BIS치。방법대60례입주아의원EICU적로뇌손상적환자수궤분성사조（매조15례）。기중삼조채용불동적BIS치（Ⅰ조55～65，Ⅱ조65～75，Ⅲ조75～85）작위반궤공제조건，폐배파공수주이병분실시진정；제Ⅳ조근거환자정황채용보통미량빙수주이병분진행진정작위대조。재진정치료개시후제1h、이후적매8h수집환자적뇌미투석액，수집시간위48h。수집출혈조주위수중대뇌조직투석액용미투석의측정포도당（ Glu）、유산（ Lac）화감유（ Gly）농도。결과사조환자적Glu、Lac급Gly수평변화재조간량량비교적SLD－t검험중，결과존재명현차이（P＜0．001）。결론채용BIS치반궤공제폐배파공수주계통수주이병분진행로뇌창상환자적진정，대로뇌창상환자신경세포대사지표유불동영향，BIS치위55～65시유교호적뇌보호작용，단당BIS치공제재55～65시부즉진정치료최이상적BIS치，기부작용여하치득진일보연구。
Objective In this study, we investigated the method ofBIS monitor bispectral index-onclosed loop -target controlled infusion with propofol sedation.We aims to analyze the biochemical indexes changes of patients with intracranial craniocerebral trauma in differentBIS values feedback control sedation, trying to find the most suitable BIS value of sedation therapy for brain trauma patients.Methods Sixty cases of patients with craniocerebral trauma admitted to EICU, the First Affiliated Hospital of Kunming Medical University, were randomly divided into four groups (15 cases in each group) .Three groups with different BIS values (55~65 inⅠgroup, 65~75 inⅡ group, 75~85 inⅢgroup) as a feedback control condition, the closed-loop target controlled infusion using propofol sedation;GroupⅣadopted micro-pump infusion of propofol sedation as controls in accordance with the patient's condition.Brain microdialysiswas sampled on the first hour after the sedation, and after that it was collected every 8huntil 48 h after sedation.Microdialysis from the hemorrhage surrounding swelling brain tissue was collected to measure glucose dialysate ( Glu ) , lactate ( Lac ) and glycerol ( Gly ) concentration.Results SLD-t test showed that Glu, Lac, Gly concentrations,between any two groups were significantly different ( P <0.001 ) .Conclusion BIS feedback control loop target controlled infusion system, and propofol sedation have different effects on biochemical indexes of patients with intracranial craniocerebraltrauma, when BIS value is in 55 ~65 there is a good protect effect for the brain, but when BIS value is in 55~65 whether sedation therapy is optimalis unclear, the side effects needsto be further identified.