脑电双频指数监测对机械通气患者镇静深度评估的研究

目的 观察脑电双频指数(BIS)监测与主观评分的相关性,研究其对机械通气患者镇静深度评估的可行性.方法 将重症监护病房(ICU)需要机械通气的83例患者随机分为两组,设定镇静目标为镇静一躁动评分(SAS)3～4分,分别用BIS(研究组,42例)和SAS(对照组,41例)监测患者的镇静深度,记录两组患者镇静前及镇静后每隔16 h的呼吸、循环指标和BIS、SAS、Ramsay 3种镇静评分,比较组间差异,分析各种评分的相关性.结果 83例患者均达镇静目标,两组间呼吸、循环指标比较差异均无统计学意义(P均>0.05).所有患者镇静后呼吸频率、吸入氧浓度较镇静前显著下降,脉搏血氧饱和度显著升高,差异均有统计学意义(P均<0.05);BIS值与主观评分间相关性良好,其中BIS与SAS评分呈显著正相关(r=0.626,P<0.05),与Ramsay评分呈显著负相关(r=-0.650,P<0.05),SAS与Ramsay评分呈显著负相关(r=0.908,P<0.05).结论 用BIS监测评估机械通气患者镇静深度简单方便、同步有效,是评价ICU机械通气患者镇静深度的良好客观指标.

A study of bispectral index monitoring in assessing the depth of sedation of patients under mechanical ventilation

Objective To investigate the correlation between subjective scoring and bispectral index (BIS) monitoring, and to study the feasibility of BIS monitor in assessing the depth of sedation for mechanically ventilated patients. Methods A prospective randomized controlled trial was conducted. The sedation target was sedation-agitation scale (SAS) 3 - 4. A total of 83 patients in the intensive care unit were assigned to receive the sedation based on BIS monitor (42 eaese) or the sedation based on subjective scale SAS (41 eases). The parameters of respiration, circulation, and the depth of sedation (BIS, SAS, Ramsay) were recorded. The difference between the two groups was compared. The correlation index and significance were calculated. Results A total of 83 patients of two groups reached the sedation target. Statistically significant difference was found between two groups in respiratory rate, fraction of inspiratory oxygen, and pulse saturation of oxygen before and after sedation (all P<0.05). After sedation, respiratory rate and fraction of inspiratory oxygen declined in all patients, while pulse saturation of oxygen rose obviously (all P<0. 05). Statistically significant difference was also found in different correlation index. There was positive correlation index between BIS and SAS (r=0. 626, P<0. 05), a negative correlation index between BIS and Ramsay (r=-0. 650, P<0. 05), and also a negative correlation index between SAS and Ramsay (r=- 0. 908, P<0.05). Statistically significant difference was not found in the parameters of respiration and circulation between the two groups. Conclusion BIS monitor is feasible for assessing the depth of sedation in mechanically ventilated patients.