双谱指数与镇静躁动评分在指导镇静治疗中的比较：一项针对短期机械通气患者的随机对照研究

[A comparison of bispectral index and sedation agitation scale in guiding sedation therapy: a randomized controlled study in patients undergoing short term mechanical ventilation].

作者信息

Zhao Dong, Xu Yuan, He Wei, Li Tong, He Yin

机构信息

Department of Intensive Care Unit, Beijing Tongren Hospital, Capital Medical University , Beijing 100730, China.

出版信息

Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2011 Apr;23(4):220-3.

PMID:21473824

Abstract

OBJECTIVE

To compare the value of bispectral index (BIS) monitoring and sedation agitation scale (SAS) in guiding intensive care unit (ICU) sedation therapy for the patients undergoing short term mechanical ventilation.

METHODS

One hundred and five patients aged 18-60 years after operation receiving mechanical ventilation for longer than 12 hours in ICU were enrolled in this study. The patients were randomly divided into two groups: BIS guided group (n=42) and SAS guided group (n=63). All of them received protocolized continuous sedation and analgesia by using fentanyl for analgesia and propofol plus midazolam to sedate intravenously. The effect of sedation was assessed every hour till BIS reaching 50-70 or SAS reaching grade 3-4. Sedatives and analgesics were suspended at 6:00 am on next day after ICU admission , and BIS and the SAS were recorded every hour, sedation time, time to wake up, duration of mechanical ventilation, daily dosage of midazolam and propofol, and the incidence of adverse events including restlessness after suction, endotracheal tube resistance, pain tolerance during sedation, and delirium after extubation were all recorded accordingly.

RESULTS

Dosages of midazolam and propofol were found higher in BIS guided group than the SAS guided group [midazolam (mg×kg(-1) ×h(-1) ): 0.10±0.02 vs. 0.09±0.02, propofol (mg×kg(-1) ×h(-1) ): 0.95±0.23 vs. 0.86±0.20, both P<0.05]. The total time (D t) of patients under sedative control was significantly longer in BIS guided group compared with SAS guided group, and also in first three hours [D 1, D 2, D 3, D t: 75.2% (507) vs. 52.8% (421), D 1: 78.6% (33) vs. 22.2% (14), D 2: 88.1% (37) vs. 20.6% (13), D 3: 81.0% (34) vs. 31.7% (20), all P<0.01]. The time to wake up (minutes) was significantly shorter in BIS guided group compared with SAS guided group [0 (0, 20) vs. 15 (0, 47), P<0.05]. No significant difference in acute physiology and chronic health evaluation II (APACHE II) score (3.57±2.60 vs. 4.19±2.30), duration of mechanical ventilation [hours: 16.5 (14.5, 19.0) vs. 17.0 (15.0, 19.0)], sedation time [hours: 14.0 (12.9, 17.1) vs. 16.0 (13.0, 18.0)] and incidence of adverse events including restlessness after suction (81.0% vs. 79.4%), endotracheal tube resistance (71.4% vs. 74.6%), pain tolerance during sedation (92.8% vs. 93.6%) and delirium after extubation (4.8% vs. 1.6%) was found between BIS guided group and SAS guided group (all P>0.05).

CONCLUSION

BIS monitoring is better in sedative control than SAS assessment for ICU patients undergoing short term mechanical ventilation.

摘要

目的

比较脑电双频指数（BIS）监测和镇静躁动评分（SAS）在指导重症监护病房（ICU）短期机械通气患者镇静治疗中的价值。

方法

选取105例年龄在18 - 60岁、术后在ICU接受机械通气超过12小时的患者。将患者随机分为两组：BIS指导组（n = 42）和SAS指导组（n = 63）。所有患者均采用规范化的持续镇静和镇痛，使用芬太尼镇痛，丙泊酚联合咪达唑仑静脉镇静。每小时评估镇静效果，直至BIS达到50 - 70或SAS达到3 - 4级。在入住ICU次日上午6:00停用镇静剂和镇痛药，并每小时记录BIS和SAS、镇静时间、苏醒时间、机械通气时间、咪达唑仑和丙泊酚的每日用量，以及相应记录包括吸痰后躁动、气管导管阻力、镇静期间疼痛耐受和拔管后谵妄等不良事件的发生率。

结果

发现BIS指导组咪达唑仑和丙泊酚的用量高于SAS指导组[咪达唑仑（mg×kg⁻¹×h⁻¹）：0.10±0.02 vs. 0.09±0.02，丙泊酚（mg×kg⁻¹×h⁻¹）：0.95±0.23 vs. 0.86±0.20，均P<0.05]。与SAS指导组相比，BIS指导组患者在镇静控制下的总时间（Dt）显著更长，且在前三个小时也是如此[D1、D2、D3、Dt：75.2%（507）vs. 52.8%（421），D1：78.6%（33）vs. 22.2%（14），D2：88.1%（37）vs. 20.6%（13），D3：81.0%（34）vs. 31.7%（20），均P<0.01]。与SAS指导组相比，BIS指导组的苏醒时间（分钟）显著更短[0（0，20）vs. 15（0，47），P<0.05]。BIS指导组和SAS指导组在急性生理与慢性健康状况评分II（APACHE II）（3.57±2.60 vs. 4.19±2.30）、机械通气时间[小时：16.5（14.5，19.0）vs. 17.0（15.0，19.0）]、镇静时间[小时：14.0（12.9，17.1）vs. 16.0（13.0，18.0）]以及包括吸痰后躁动（81.0% vs. 79.4%）、气管导管阻力（71.4% vs. 74.6%）、镇静期间疼痛耐受（92.8% vs. 93.6%）和拔管后谵妄（4.8% vs. 1.6%）等不良事件的发生率方面均未发现显著差异（均P>0.05）。