脑电双频指数对机械通气患儿镇静深度可行性评价

目的研究脑电双频指数（BIS）评估机械通气患儿镇静深度的可行性。方法对ICU（intensivecareunit）42例4—12岁机械通气患儿采用咪达唑仑维持镇静。每4h运用Ramsay评分评估镇静深度,同时记录BIS值。就BIS值与镇静评分间进行相关分析;计算BIS判断镇静深度的敏感度和阳性预测值。结果BIS值与对应的Ramsay评分呈显著负相关（r为-0．71,P值〈0．01）。BIS值为80时,其区别镇静不足和镇静充分的敏感度为0．84和0．81,阳性预测值分别为0．66和0．79;BIS值为55时,区别镇静充分和镇静过度的敏感度分别为0．67和0．65,阳性预测值为0．39和0．21。结论对在ICU机械通气患儿采用咪达唑仑维持镇静,BIS值与Ramsay评分有良好的相关性,并能可靠、有效地区分镇静不足和镇静充分。     

亨特氏综合征的临床观察与护理

目的探讨亨特氏综合征的护理方法。方法对3例亨特氏综合征患者的临床资料进行回顾性分析。结果经过积极治疗和精心护理,患者康复出院。结论药物治疗、做好基础护理及心理护理是亨特氏综合征患者治疗和康复的重要保证。     

Assessing sedation in critically ill children by bispectral index, auditory-evoked potentials and clinical scales

Objective  To evaluate the correlation and agreement between the bispectral index (BIS), middle latency auditory-evoked potential index (AEP index), Ramsay scale (RS) and COMFORT scale (CS) for evaluation of the level of sedation in critically ill children. Design  Prospective observational study. Setting  Pediatric critical care unit. Patients  Seventy-seven critically ill children receiving sedation and mechanical ventilation. Measurements and results  Simultaneous recording of BIS, AEP index, RS and CS were performed once a day, for a maximum of 5 days. Two levels of sedation were categorized: light–moderate versus deep–very deep. Correlations between methods were determined using Spearman rank correlation test and the agreement using Cohen’s Kappa test. The correlation and agreement between the four methods was moderate-to-good. Correlation was not found in paralyzed children. There was no correlation between the four methods and the heart rate or blood pressure, or with the type or dose of sedative medication. Receiver-operating characteristic (ROC) analysis revealed best discrimination between light–moderate and deep–very deep sedation at BIS and AEP index values of 63.5 and 33.5 when the level of sedation was classified by the RS, and at BIS and AEP index values of 67 and 37.5, respectively, when the level of sedation was classified by the CS. Conclusion  There is a moderate-to-good correlation and agreement of BIS and AEP index with the clinical scales in critically ill children without neuromuscular blockade. BIS and AEP index could be useful to evaluate the level of sedation in critically ill children with and without neuromuscular blockade.     

酒石酸布托啡诺与芬太尼联合用于妇科患者术后静脉自控镇痛的临床研究

目的观察酒石酸布托啡诺与芬太尼合用于术后静脉自控镇痛(PCIA)的效果及最佳混合比例。方法 2010年8月-2011年1月100例妇科手术患者,随机分为5组,每组20例。均全身麻醉术后采用负荷量+持续背景剂量+PCIA方案镇痛。根据不同配方分为F组:芬太尼1 mg+生理盐水至100 mL;B组:酒石酸布托啡诺10 mg+生理盐水至100 mL;BFⅠ组:芬太尼0.6 mg+酒石酸布托啡诺3 mg+生理盐水至90 mL;BFⅡ组:芬太尼0.5 mg+酒石酸布托啡诺5 mg+生理盐水至100 mL;BFⅢ组:芬太尼0.3 mg+酒石酸布托啡诺6 mg+生理盐水至90 mL。观察术后各时点视觉模拟评分(VAS)及镇静评分,患者满意度以及不良反应情况。结果术后早期BFⅢ组和B组VAS评分大于F组;镇静评分B组大于F组;B组满意度优良率小于其余各组;恶心呕吐发生率F组高于BFⅠ组及BFⅡ组。结论酒石酸布托啡诺和芬太尼合用于PCIA,镇痛效果确切,不良反应发生率低。推荐配比:BFⅠ组和BFⅡ组。     

Narcotrend与Ramsay在机械通气患者镇静中的相关性研究

目的 探讨Narcotrend麻醉/脑电意识深度监测系统在丙泊酚靶控输注(TCI)下对ICU机械通气患者镇静深度数字化监测的可行性.方法 选取20例ICU呼吸机机械通气同时进行丙泊酚靶控输注镇静患者,应用Narcotrend进行监测.靶控浓度(Ct)从0.5 ug/ml开始递增,达到满意镇静深度为止,观察NTI、Ramsay评分.结果 丙泊酚滴定法靶控输注镇静时NTI随着Ct递增而递减,Ramsay评分随着Ct递增而递增,NTI与Ramsay呈负相关,相关系数r为-0.887;NTI与Ct呈负相关,相关系数r为-0.756; Ramsay评分与Ct呈正相关,相关系数r为0.735 (P＜0.01).结论 Narcotrend在机械通气患者丙泊酚TCI镇静深度评估中具有较好的相关性和可控性,可以对丙泊酚TCI镇静实现数字化监测.     

脑电双频指数在调控丙泊酚镇静深度中的价值

目的 探讨危重症患者脑电双频指数对丙泊酚镇静深度调控的价值.方法 选取重症监护病房66例危重症患者,静脉持续泵入丙泊酚,以Ramsay评分3～4为镇静目标,连续观察24 ～ 72 h,记录每半小时的Ramsay评分及对应的BIS值,共监测Ramsay评分及相应BIS值202组,分析Ramsay评分与BIS值的相关性,确定镇静适度时所对应的最佳BIS值.结果 ICU危重症患者丙泊酚镇静期间Ramsay评分与BIS值呈负相关,r=-0.876（P＜0.01）.结论 脑电双频指数是调控丙泊酚镇静深度的有效指标.     

PRKCG mutation (SCA-14) causing a Ramsay Hunt phenotype.

Progressive myoclonic ataxia, also referred to as Ramsay Hunt syndrome, is characterized by a combination of myoclonus and cerebellar ataxia, infrequently accompanied by tonic-clonic seizures. Its differential diagnosis overlaps with progressive myoclonic epilepsy, a syndrome with myoclonus, tonic-clonic seizures, progressive ataxia and dementia. In patients with progressive myoclonic epilepsy, specific diseases can frequently be recognized, but the diagnostic yield in progressive myoclonic ataxia is much lower. We describe a patient who presented with multifocal myoclonus in his thirties and who later developed cerebellar ataxia and focal dystonia. His father was similarly affected. Genetic studies revealed a mutation in the protein kinase C gamma (PRKCG) gene, known to cause spinocerebellar ataxia type 14 (SCA-14). This case illustrates that both myoclonus and dystonia are part of the clinical spectrum in SCA-14 and that myoclonus can even be the presenting symptom. We suggest that SCA-14 should be considered in the differential diagnosis of progressive myoclonic ataxia.