熵指数与脑电双频指数监测ICU长时间镇静的比较

目的比较ICU内需要长时间镇静的患者，使用右美托咪定联合咪达唑仑镇静治疗过程中熵指数监测与脑电双频指数（BIS）监测的镇静评估差别，寻找合适的镇静监测方案。 方法选取2013年9月至2015年9月在我院ICU住院且需要长时间镇静（镇静时间＞3 d）的患者65例，按照单盲随机数字表法将其随机分为2组，即熵指数监测组（A组，32例）和BIS监测组（B组，33例）。患者镇静目标为：躁动-镇静评分（RASS）-1~0分，A组熵指数目标值反应熵（RE） 65~80，状态熵（SE） 60~75；B组BIS目标值60~80。镇静过程中持续心电、指脉氧监护，监测有创动脉压力，评估镇静满意程度，记录2组患者到达镇静目标使用的时间、前3天使用镇静药物剂量变化，并监测患者不良反应发生情况。 结果A组较B组更快到达镇静目标［（3.78±1.38）h vs （5.78±2.17）h，P=0.0047］，镇静满意程度显著提高［（78.2±15.4）% vs （56.7±11.7）%，P=0.0034］，用药量变化幅度较小，不良反应发生相对减少。 结论对于ICU长时间镇静的患者使用持续熵指数监测可以减少镇静药物的使用剂量，使患者更短时间达到镇静目标，并减少不良反应的发生。

Comparison of entropy index and bispectral index on monitoring the depth of sedation in ICU

ObjectiveTo compare effects between entropy index and bispectral index on monitoring the depth of sedation induced by Dexmedetomidine combined with Midazolam for patients requiring long-term sedation in ICU. Methods65 patients sedated over 3 days in ICU from September 2013 to September 2015 were enrolled. The patients were randomly divided into two groups according to the sigle blind random number table methed. Group A (n=32): entropy group; Group B (n=33): BIS group. The target of RASS score is between -1 to 0 for both group, while the entropy index target in Group A is RE 65-80, SE 60-75, and BIS target in group B is from 60 to 80. During investigation, heart rate, respiratory rate, mean arterial pressure, and sedation satisfaction were monitored continuously. The time to achieve the desired sedation level and the dosage of sedatives in the first three days were recorded. Meanwhile, the incidence of adverse reactions was monitored respectively. ResultsIt taked less time to achieve the desired sedation level in Group A than that in Group B (3.78±1.38) h vs (5.78±2.17) h, P=0.0047]. Group A had more effective sedation (78.2±15.4)% vs (56.7±11.7)%, P=0.0034], less adverse reactions and lower dosage of sedatives than those in Group B. ConclusionEntropy index can be applied to monitor the depth of sedation in patients requiring long-term sedation, and reach sedation target in a shorter time, reduce the dosage of sedatives and adverse reactions as well.