Hardin Kimberly A, Seyal Masud, Stewart Ted, Bonekat H William
Department of Internal Medicine, University of California, Davis, Sacramento, CA 95817, USA.
Chest. 2006 Jun;129(6):1468-77. doi: 10.1378/chest.129.6.1468.
To determine sleep characteristics in patients receiving mechanical ventilation who require a neuromuscular blocking agent (NMBA).
Observational study.
Adult medical ICU at a university hospital.
Eighteen patients with respiratory failure requiring mechanical ventilation were classified into three groups based on medication regimen determined a priori: intermittent sedation (IS), continuous sedation (CS), or CS and an NMBA.
Twenty-four-hour polysomnography was performed to determine sleep architecture and fragmentation. Measurement of severity of illness, laboratory indexes, patient-care interventions, and drug dosage were compared between groups, and the effects on sleep staging and fragmentation were analyzed. Sleep stages were scored manually using criteria of Rechtschaffen and Kales, as well as by a modified 50-muV voltage criteria for scoring delta activity.
All patients demonstrated abnormal sleep architecture. In each group of patients, the total sleep time (TST) was > 10 h. There was no statistical difference in the delta activity between the two scoring methods; delta activity was increased in all groups: 32.9%, 49.6%, and 43.7% in the IS, CS, and CS/NMBA groups, respectively. Patients receiving NMBAs spent 22% of the sleep period awake. Rapid eye movement sleep could not be detected in the patients receiving NMBAs and was reduced in the other two groups (3.5%). TST, sleep stage, or arousal/awakening index were not statistically correlated with either severity of illness, clinical laboratory indexes, drug dosage, patient-care interventions, or mode of mechanical ventilation.
TST during a 24-h period is not reduced in patients requiring mechanical ventilation. Delta activity is increased and may reflect age, drug, or a contributing metabolic process. The effect of wakefulness in patients receiving chemical paralysis on recovery and weaning from mechanical ventilation, and overall clinical outcome is unknown.
确定接受机械通气且需要使用神经肌肉阻滞剂（NMBA）的患者的睡眠特征。
观察性研究。
大学医院的成人医学重症监护病房。
18例因呼吸衰竭需要机械通气的患者，根据预先确定的用药方案分为三组：间歇性镇静（IS）组、持续镇静（CS）组或CS加NMBA组。
进行24小时多导睡眠图检查以确定睡眠结构和睡眠片段化情况。比较各组间疾病严重程度、实验室指标、患者护理干预措施和药物剂量的测量结果，并分析其对睡眠分期和睡眠片段化的影响。使用 Rechtschaffen 和 Kales 的标准以及修改后的50 μV 电压标准对δ波活动进行手动评分来确定睡眠阶段。
所有患者均表现出异常的睡眠结构。每组患者的总睡眠时间（TST）均>1小时。两种评分方法之间的δ波活动无统计学差异；所有组的δ波活动均增加：IS组、CS组和CS/NMBA组分别为32.9%、49.6%和43.7%。接受NMBA的患者在睡眠期间有22%的时间处于清醒状态。接受NMBA的患者未检测到快速眼动睡眠，其他两组的快速眼动睡眠减少（3.5%）。TST、睡眠阶段或觉醒/唤醒指数与疾病严重程度、临床实验室指标、药物剂量、患者护理干预措施或机械通气模式均无统计学相关性。
需要机械通气的患者在24小时内的TST并未减少。δ波活动增加，可能反映年龄、药物或相关的代谢过程。接受化学性麻痹的患者清醒状态对机械通气的恢复和撤机以及总体临床结局的影响尚不清楚。
