BIS闭环靶控输注异丙酚对ICU应激患者的镇静和胃酸的影响

目的比较不同的脑电双频指数（BIS）闭环靶控输注异丙酚用于ICU患者的镇静，寻找最适的BIS值．方法随机选取30例入住EICU的患者分为3组，采取不同的BIS值（Ⅰ组55～65，Ⅱ组65-75，Ⅲ组75～85）作为反馈条件，闭环靶控输注异丙酚用于患者的镇静，记录患者镇静前及镇静后每小时的Ramsay镇静评分及心率（RR）、平均动脉压（MAP）、胃酸pH值和使用异丙酚的总量，观察24h．结果随着BIS值的逐渐降低，Ramsay镇静评分的值变动于3～5之间；Ⅱ组和Ⅲ组的胃酸pH值间无明显变化（P〉0．05），Ⅰ组的胃酸pH值较Ⅲ组为低（P〈0．05）；Ⅱ、Ⅲ组的HR、MAP在镇静前后无明显变化，Ⅰ组有所降低（P〈0．05）；Ⅲ组异丙酚用量明显较Ⅰ组为少（P〈0．05）．结论BIS监测能很好的反映患者的镇静深度．应根据患者的BIS值指导性预防应激性溃疡的发生，并按患者病情要求来实施“个体化”镇静．

Effects of Bispectral Index-onclosed Loop-target Controlled Infusion with Propofol Sedation and Gastric Acid of ICU Stress Ulcer Patients

Obiective To compare the effects between different bispectral index-closed loop-target controlled infusion with propofol on sedation of ICU critical illness patients, and search the best bispectral index. Methods 30 ICU critical illness patients in EICU were randomly divided into three groups.By closed loop-target controlled infusing propofol feed back with different bispectral index, the BIS of groups Ⅰ , Ⅱ and m were 55 - 65, 65 - 75 and 75 - 85, respectively. We recorded the Ramsay score, HR, MAP, pH valhe of gastric acid per-hour and the total dose of propofol with the pre-sedation and after sedation in 24 hours. Results With the decrease of the bispectral index, score of Ramsay eh gastric acid pH value of the patients between group Ⅱ anged between 3 to 5; there and m （P〉0.05） while was no significant difference in there was significant difference between the group Ⅰ and m. Compared with the pre-sedation, HR and MAP didn＇t change in the groupⅡ and Ⅱ after sedation, while decreased in group Ⅰ （P 〈 0.05 ）. The total dose of propofol in group Ⅲ was less than ingroup Ⅰ remarkably （P 〈 0.05）. Conclusion The application of BIS can make good judgement in the sedation. It shoud be choose the ＂individuation＂ sedation proposal according to ICU critical illness patients＇ different condition.