BIS 闭环靶控镇静对颅脑创伤患者脑细胞代谢生化指标的影响

Effects of Bispectralindex -onclosedloop -target controlled infusion with propofolsedation onbiochemical indexesof patients with intracranial craniocerebraltrauma

目的：利用BIS监测仪反馈控制闭环靶控输注系统进行异丙酚镇静，研究在不同BIS值反馈控制镇静程度下，颅脑创伤患者细胞代谢生化指标的变化，试图寻找对脑创伤患者最适宜镇静治疗的BIS值。方法对60例入住我医院EICU的颅脑损伤的患者随机分成四组（每组15例）。其中三组采用不同的BIS值（Ⅰ组55～65，Ⅱ组65～75，Ⅲ组75～85）作为反馈控制条件，闭环靶控输注异丙酚实施镇静；第Ⅳ组根据患者情况采用普通微量泵输注异丙酚进行镇静作为对照。在镇静治疗开始后第1h、以后的每8h收集患者的脑微透析液，收集时间为48h。收集出血灶周围水中带脑组织透析液用微透析仪测定葡萄糖（ Glu）、乳酸（ Lac）和甘油（ Gly）浓度。结果四组患者的Glu、Lac及Gly水平变化在组间两两比较的SLD－t检验中，结果存在明显差异（P＜0．001）。结论采用BIS值反馈控制闭环靶控输注系统输注异丙酚进行颅脑创伤患者的镇静，对颅脑创伤患者神经细胞代谢指标有不同影响，BIS值为55～65时有较好的脑保护作用，但当BIS值控制在55～65是否即镇静治疗最理想的BIS值，其副作用如何值得进一步研究。

Objective In this study, we investigated the method ofBIS monitor bispectral index-onclosed loop -target controlled infusion with propofol sedation.We aims to analyze the biochemical indexes changes of patients with intracranial craniocerebral trauma in differentBIS values feedback control sedation, trying to find the most suitable BIS value of sedation therapy for brain trauma patients.Methods Sixty cases of patients with craniocerebral trauma admitted to EICU, the First Affiliated Hospital of Kunming Medical University, were randomly divided into four groups （15 cases in each group） .Three groups with different BIS values （55~65 inⅠgroup, 65~75 inⅡ group, 75~85 inⅢgroup） as a feedback control condition, the closed-loop target controlled infusion using propofol sedation;GroupⅣadopted micro-pump infusion of propofol sedation as controls in accordance with the patient＇s condition.Brain microdialysiswas sampled on the first hour after the sedation, and after that it was collected every 8huntil 48 h after sedation.Microdialysis from the hemorrhage surrounding swelling brain tissue was collected to measure glucose dialysate （ Glu ） , lactate （ Lac ） and glycerol （ Gly ） concentration.Results SLD-t test showed that Glu, Lac, Gly concentrations,between any two groups were significantly different （ P 〈0.001 ） .Conclusion BIS feedback control loop target controlled infusion system, and propofol sedation have different effects on biochemical indexes of patients with intracranial craniocerebraltrauma, when BIS value is in 55 ~65 there is a good protect effect for the brain, but when BIS value is in 55~65 whether sedation therapy is optimalis unclear, the side effects needsto be further identified.