Tonner Peter H, Paris Andrea, Scholz Jens
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, 24105 Kiel, Germany.
Best Pract Res Clin Anaesthesiol. 2006 Mar;20(1):191-200. doi: 10.1016/j.bpa.2005.08.011.
Sedation and analgesia are important components of care for critically ill patients. Avoiding over-as well as undersedation is of utmost importance as both states carry considerable risks and may influence outcome. The management of sedation has changed dramatically over the past two decades from providing a dosage level by which the patient was kept in a deep stage of anaesthesia to a current dosing strategy allowing the administration of drugs in line with individual need, resulting in most cases in a slightly sedated, cooperative patient. The importance of monitoring the level of sedation and analgesia has only recently been realised. Most importantly, regularly determining the appropriate level of sedation and analgesia as well as monitoring the desired level of sedation will help to minimise the adverse effects of sedation. Clinical sedation scales are, however, subjective, and most lack proper validation. Thus, an objective measure of sedation, such as the use of processed electroencephalogram (EEG) parameters is desirable. Processed EEG algorithms such as the bispectral index were initially introduced into clinical practice as a tool to assess the depth of anaesthesia objectively in the operating room. However, patients under general anaesthesia differ from those in an intensive care unit. Accordingly, most results from studies evaluating the performance of processed EEG parameters in critically ill patients have not been satisfactory. At present, monitoring sedation with processed EEG parameters cannot generally be recommended. However, in special situations such as deep sedation and neuromuscular blockade, in which clinical sedation scales are prone to failure, the bispectral index may help to assess the level of sedation.
镇静和镇痛是重症患者护理的重要组成部分。避免过度镇静和镇静不足至关重要，因为这两种状态都有相当大的风险，且可能影响预后。在过去二十年中，镇静管理发生了巨大变化，从提供使患者处于深度麻醉状态的剂量水平，转变为当前根据个体需求给药的策略，在大多数情况下可使患者轻度镇静且配合治疗。监测镇静和镇痛水平的重要性直到最近才被认识到。最重要的是，定期确定适当的镇静和镇痛水平以及监测期望的镇静水平将有助于将镇静的不良反应降至最低。然而，临床镇静量表具有主观性，且大多数缺乏适当的验证。因此，需要一种客观的镇静测量方法，例如使用处理后的脑电图（EEG）参数。诸如脑电双频指数等处理后的EEG算法最初作为一种在手术室客观评估麻醉深度的工具引入临床实践。然而，全身麻醉下的患者与重症监护病房的患者不同。因此，大多数评估处理后的EEG参数在重症患者中性能的研究结果并不令人满意。目前，一般不推荐使用处理后的EEG参数监测镇静。然而，在诸如深度镇静和神经肌肉阻滞等临床镇静量表容易失效的特殊情况下，脑电双频指数可能有助于评估镇静水平。
