脑电双频指数反馈控制下的异丙酚闭环靶控输注在ICU镇静中的应用价值

目的探讨脑电双频指数（BIS）反馈控制下的闭环靶控镇静（CLTC）I技术应用于ICU机械通气患者镇静治疗的可行性和应用价值.方法接受机械通气治疗的30例患者,随机分为3组,Ⅰ组使用微量泵连续输注异丙酚进行镇静,Ⅱ组使用靶控输注（TC）I异丙酚进行镇静;Ⅲ组使用闭环靶控输注异丙酚进行镇静,闭环靶控的目标BIS值设定为80～70,记录平均动脉压（MAP）、心率（HR）、BIS值、Ramsay评分情况和三组24h异丙酚平均使用量.结果镇静治疗开始后,三组平均动脉压与基础值比较均有下降（P〈0.05）,三组MAP下降幅度无明显差异（P〉0.05）,三组患者心率与基础值比较变化不明显（P〉0.05）;各组BIS值和Ramsay评分具有较好的相关性;Ⅲ组维持理想镇静时间百分比与其它组比较有明显差异（P〈0.05）;Ⅲ组达到60～80范围BIS值时间百分比与其它组比较有明显差异（P〈0.05）;Ⅲ组24 h异丙酚平均用量明显少于其它组（P〈0.05）.结论CLTCI与TCI和恒速输注方法比较,是更为理想的镇静方法,CLTCI能够在提供较为理想的镇静效果同时保持患者血液动力学的相对稳定,有效减少镇静不足或过度镇静的发生,并减少镇静药物的使用量.

Aplication of Closed Loop of Target Controlled Infusion Feedback with Bispectral Index in Sedation of ICU Patients

Objective To discuss the applicability and value of CLTCI feedback with BIS index in the patients who are required ventilation in ICU.Methods Thrity critical patients undergoing mechanical ventilation in ICU were randomly divided into three groups,and every group included 10 patients.GroupⅠwas the group of propofol for sedation with micro pump infusion.GroupⅡ was the group of propofol with TCI for sedation.GroupⅢ was the group of propofol with CLTCI which target scope of BIS value was setted from 80 to 70 for sedation.MAP,HR,BIS value,Ramsay score,and the average consumption of propopol in each group for 24 hours were recorded.Results After sedation therapy,the MAP of 3 groups were reduced comparing with the basic values,and the difference of MAP was significant in each group（P0.05）.The extent of MAP reduction had no significant difference among groups（P0.05）.For HR,there was no significant difference comparing with the basic value in each group（P0.05）.The correlation was proved between BIS and Ramsay score in each group.For the percent of time of maintaining the patients on condition of ideal sedation,groupⅢ comparing withⅠand Ⅱ,there was a significant difference（P0.05）.For the percent of time of BIS within the range from 80 to 70,group Ⅲ comparing withⅠand Ⅱ,there was a significant difference（P0.05）.The average consumption of propopol of groupⅢ was less than others（P0.05）.Conclusion CLTCI is a better means of sedation comparing with TCI and micro pump infusion,and it can provide ideal level of sedation without inadequate or excessive sedation,keep the relative stability of hemadynamics,and reduce the average consumption of propopol effectively.