Miner James R, Biros Michelle H, Heegaard William, Plummer David
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA.
Acad Emerg Med. 2003 Jun;10(6):638-43. doi: 10.1111/j.1553-2712.2003.tb00048.x.
To determine whether there is a correlation between the level of sedation achieved during procedural sedation (PS) in the emergency department as determined by bispectral electroencephalographic (EEG) analysis (BIS) and the rate of respiratory depression (RD), the patient's perception of pain, recall of the procedure, and satisfaction.
This was a prospective observational study conducted in an urban county hospital of adult patients undergoing PS using propofol, methohexital, etomidate, and the combination of fentanyl and midazolam. Consenting patients were monitored by vital signs, pulse oximetry, nasal-sample end-tidal carbon dioxide (ETCO(2)), and BIS monitors during PS. Respiratory depression (RD) was defined as an oxygen saturation <90%, a change from baseline ETCO(2) of >10 mm Hg, or an absent ETCO(2) waveform at any time during the procedure. After the procedure, patients were asked to complete three 100-mm visual analog scales (VASs) concerning their perception of pain, recall of the procedure, and satisfaction with the procedure. Patients were divided into four groups based on the lowest BIS score recorded during the procedure, group 1, >85; group 2, 70-85; group 3, 60-69; group 4, <60. Rates of RD and VAS outcomes were compared between groups using chi-square statistics.
One hundred eight patients were enrolled in the study. No serious adverse events were noted. RD was seen in three of 14 (21.4%) of the patients in group 1, seven of 34 (20.6%) in group 2, 16 of 26 (61.5%) in group 3, and 18 of 34 (52.9%) in group 4. The rate of RD in patients in group 2 was not significantly different from that in group 1 (p = 0.46). The rate of RD in group 2 was significantly lower than that in groups 3 (p = 0.0003) and 4 (p = 0.006). For the VAS data, when group 1 was compared with the combined groups 2, 3, and 4, it had significantly higher rates of pain (p = 0.003) and recall (p = 0.001), and a dissatisfaction rate (p = 0.085) that approached significance. When groups 2, 3, and 4 were compared with chi-square test, there was not a significant difference in pain (p = 0.151), recall (p = 0.27), or satisfaction (p = 0.25).
Patients with a lowest recorded BIS score between 70 and 85 had the same VAS outcomes as more deeply sedated patients and the same rate of RD as less deeply sedated patients. This range of scores represented the optimally sedated patients in this study.
通过双谱脑电图（EEG）分析（BIS）来确定急诊科程序性镇静（PS）期间达到的镇静水平与呼吸抑制（RD）发生率、患者对疼痛的感知、对操作的回忆以及满意度之间是否存在相关性。
这是一项在城市县级医院进行的前瞻性观察性研究，研究对象为使用丙泊酚、美索比妥、依托咪酯以及芬太尼和咪达唑仑联合用药进行PS的成年患者。在PS期间，对同意参与研究的患者进行生命体征、脉搏血氧饱和度、鼻腔采样呼气末二氧化碳（ETCO₂）以及BIS监测。呼吸抑制（RD）定义为氧饱和度<90%、ETCO₂较基线变化>10 mmHg或在操作过程中任何时间ETCO₂波形消失。操作结束后，要求患者完成三个100毫米视觉模拟量表（VAS），分别涉及他们对疼痛的感知、对操作的回忆以及对操作的满意度。根据操作期间记录的最低BIS评分，将患者分为四组，第1组，>85；第2组，70 - 85；第3组，60 - 69；第4组，<60。使用卡方统计比较各组之间的RD发生率和VAS结果。
108例患者纳入研究。未观察到严重不良事件。第1组14例患者中有3例（21.4%）出现RD，第2组34例患者中有7例（20.6%），第3组26例患者中有16例（61.5%），第4组34例患者中有18例（52.9%）。第2组患者的RD发生率与第1组无显著差异（p = 0.46）。第2组的RD发生率显著低于第3组（p = 0.0003）和第4组（p = 0.006）。对于VAS数据，当将第1组与第2、3、4组合并组进行比较时，第1组的疼痛发生率（p = 0.003）和回忆发生率（p = 0.001）显著更高，不满意率（p = 0.085）接近显著水平。当对第2、3、4组进行卡方检验比较时，疼痛（p = 0.151）、回忆（p = 0.27）或满意度（p = 0.25）方面无显著差异。
记录的最低BIS评分在70至85之间的患者，其VAS结果与深度镇静患者相同，RD发生率与浅度镇静患者相同。在本研究中，这个评分范围代表了镇静效果最佳的患者。
