Intensive Care Unit, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung First Road, Kaohsiung City 813, Taiwan.
BMC Pulm Med. 2014 Feb 6;14:15. doi: 10.1186/1471-2466-14-15.
Appropriate sedation benefits patients by reducing the stress response, but it requires an appropriate method of assessment to adjust the dosage of sedatives. The aim of this study was to compare the difference in the sedation of mechanically ventilated patients undergoing flexible bronchoscopy (FB) monitored by auditory-evoked potentials (AEPs) or the Ramsay sedation scale (RSS).
In a prospective, randomized, controlled study, all patients who underwent FB with propofol sedation were monitored and their sedation adjusted. During FB, one group was monitored by AEP and another group was monitored by RSS. The propofol dosage was adjusted by the nursing staff during examination to maintain the Alaris AEP index (AAI) value between 25 and 40 in the AEP group and the RSS at 5 or 6 in the RSS group. Before FB and during FB, the AAI, heart rate (HR), and mean arterial pressure (MAP) were recorded every 5 min. The percentages of time at the sedation target and the propofol dosages were calculated.
Nineteen patients received AEP monitoring and 18 patients received RSS monitoring. The percentage of time at the sedation target during FB was significantly higher in the AEP monitoring group (51.3%; interquartile range [IQR], 47.0-63.5%) than in the RSS group (15.4%; IQR, 9.5-23.4%), (P < 0.001). During FB, the RSS group had a significantly higher AAI (P = 0.011), HR (P < 0.001), and MAP (P < 0.001) than the AEP group.
In mechanically ventilated patients undergoing FB, AEP monitoring resulted in less variation in AAI, HR, and MAP, and a higher percentage of time at the sedation target than RSS monitoring.
适当的镇静可以通过减轻应激反应使患者受益，但需要采用适当的评估方法来调整镇静剂的剂量。本研究旨在比较听觉诱发电位（AEPs）或 Ramsay 镇静评分（RSS）监测下机械通气患者行纤维支气管镜检查（FB）时镇静的差异。
在一项前瞻性、随机、对照研究中，所有接受 FB 检查并接受异丙酚镇静的患者均接受监测并调整镇静。在 FB 期间，一组通过 AEP 监测，另一组通过 RSS 监测。在检查过程中，护理人员通过调整异丙酚剂量，使 AEP 组的 Alaris AEP 指数（AAI）值维持在 25 至 40 之间，RSS 组的 RSS 值维持在 5 或 6。在 FB 前和 FB 期间，每 5 分钟记录一次 AAI、心率（HR）和平均动脉压（MAP）。计算目标镇静时间百分比和异丙酚剂量。
19 名患者接受 AEP 监测，18 名患者接受 RSS 监测。在 FB 期间，AEP 监测组的目标镇静时间百分比明显高于 RSS 监测组（51.3%；四分位距[IQR]，47.0-63.5%）（P<0.001）。在 FB 期间，RSS 组的 AAI（P=0.011）、HR（P<0.001）和 MAP（P<0.001）明显高于 AEP 组。
在接受 FB 检查的机械通气患者中，与 RSS 监测相比，AEP 监测可使 AAI、HR 和 MAP 波动更小，目标镇静时间百分比更高。
