Rundshagen I, Schnabel K, Pothmann W, Schleich B, Schulte am Esch J
Department of Anaesthesiology and Intensive Care, University Hospital Charité, Berlin, Germany.
Intensive Care Med. 2000 Sep;26(9):1312-8. doi: 10.1007/s001340000591.
Assessing the level of sedation in critically ill patients remains a challenge for the intensivist in order to avoid over or under-sedation. Clinical scoring systems may fail in patients with concomitant neurological disorders or requiring muscle relaxants. We evaluated auditory (AER) and median nerve somatosensory evoked responses (MnSSER) in critically ill patients sedated with sufentanil and propofol, in order to quantify the level of sedation during therapeutic interventions.
Prospective clinical study.
Anaesthesiological intensive care unit (ICU) in a university hospital.
Thirty-two patients following major abdominal or thoracic surgery requiring sedation during their stay on the ICU.
During physiotherapy and following nursing care (tracheal suctioning) AER and MnSSER were recorded. The level of sedation was evaluated clinically in relation to vital parameters. Data were analysed by multivariate analyses of variance (Hotellings T2), Friedman test.
In comparison to baseline levels the AER latency Nb decreased, while the amplitude NaPa increased during physiotherapy and after tracheal suctioning (p < 0.001). In contrast, the MnSSER latency P25 decreased and the amplitude P25N35 increased after tracheal suctioning only (p < or = 0.001). Clinical sedation scores decreased and mean arterial blood pressure increased during physiotherapy and nursing care.
Changes of AER or MnSSER waves indicated cortical arousal in ICU patients during nursing care and physiotherapy. Further studies with evoked responses are recommended to evaluate whether bolus injections of sedatives and/or analgesics reduce cortical arousal and thereby minimise the patient's stress during nursing care.
对于重症监护医生而言，评估重症患者的镇静水平仍然是一项挑战，目的是避免镇静过度或不足。临床评分系统在伴有神经系统疾病或需要使用肌肉松弛剂的患者中可能会失效。我们评估了接受舒芬太尼和丙泊酚镇静的重症患者的听觉诱发电位（AER）和正中神经体感诱发电位（MnSSER），以便在治疗干预期间量化镇静水平。
前瞻性临床研究。
大学医院的麻醉重症监护病房（ICU）。
32例接受腹部或胸部大手术的患者，在ICU住院期间需要镇静。
在物理治疗期间以及护理操作（气管吸痰）后记录AER和MnSSER。根据生命体征参数对镇静水平进行临床评估。数据通过多变量方差分析（Hotellings T2）、Friedman检验进行分析。
与基线水平相比，在物理治疗期间和气管吸痰后，AER潜伏期Nb缩短，而波幅NaPa增加（p<0.001）。相比之下，仅在气管吸痰后，MnSSER潜伏期P25缩短，波幅P25N35增加（p≤0.001）。在物理治疗和护理期间，临床镇静评分降低，平均动脉血压升高。
AER或MnSSER波的变化表明ICU患者在护理和物理治疗期间出现皮质觉醒。建议进一步开展有关诱发电位的研究，以评估静脉注射镇静剂和/或镇痛药是否能减轻皮质觉醒，从而在护理期间将患者的应激降至最低。
