右美托咪定和丙泊酚对机械通气患者浅镇静水平脑电活动的影响

Effects of dexmedetomidine and propofol on electroencephalographic activity in mechanically ventilated patients during light sedation

目的利用量化脑电图(q EEG)观察右美托咪定和丙泊酚镇静治疗对机械通气患者浅镇静水平脑电活动的影响,评价两种药物的镇静效果。方法选择2016年4-10月入住中山大学附属第一医院重症加强治疗病房(ICU)需镇痛镇静治疗超过24 h的机械通气成人患者24例,随机分为右美托咪定组(Dex组)和丙泊酚组(Pro组),每组12例。在充分镇痛的基础上,Dex组持续泵入右美托咪定1μg/(kg·h),Pro组持续泵入丙泊酚3 mg/(kg·h),并根据镇静深度调整药物用量,维持Richmond躁动-镇静评分(RASS)在-2~1分的浅镇静目标。分别于给药0、5、15、30 min和1、12、24 h进行RASS评分。镇静开始后持续q EEG监测1 h,随后于12 h和24 h各监测30 min,选取浅镇静时的脑电信号进行2 min采样,记录波幅、相对频带能量(RSP)、95%边缘频率(SEF)等量化参数。结果两组患者24 h内各进行了84次RASS评估,Dex组和Pro组分别有76次(90.5%)和64次(76.2%)RASS评分达浅镇静目标,差异有统计学意义(P<0.05)。所有入组患者治疗24 h内振幅整合脑电图均属于正常脑电背景活动;两组振幅上、下边界差异均无统计学意义(P>0.05)。Dex组δ波RSP高于Pro组,β波RSP低于Pro组,差异均有统计学意义(P<0.05)。Pro组95%SEF高于Dex组,差异有统计学意义(P<0.05)。结论右美托咪定的浅镇静达标率更高,浅镇静状态下右美托咪定引起的δ波频带能量更高,丙泊酚引起的β波频带能量更高,右美托咪定的浅镇静效果优于丙泊酚。

Objective To observe the quantitative electroencephalogram （qEEG） changes of mechanically ventilated patients induced by dexmedetomidine and propofol during light sedation and evaluate the sedative effects of these two drugs. Methods From April 2016 to October, 24 critical ill adults receiving mechanically ventilation and sedation therapy for more than 24 hours in intensive care unit （ ICU ） of our hospital were enrolled. Participants were randomly divided into dexmedetomidine （Dex） group and propofol （Pro） group. After optimized analgesia, patients were sedated with dexmedetomidine at a starting dose of 1 μg/（kg·h）or Propofol at a starting dose of 3 mg/（kg·h）. Sedatives were titrated to achieve the desired level of light sedation as defined by a RASS range of - 2 to 1. The RASS score were assessed at O, 5, 15, 30 minutes, and 1, 12, 24 hours after administration. We continuously monitored qEEG for 1 hour at the onset of sedation and for 30 min at 12 h and 24 h. The 2 rain EEG signals during light sedation were sampled and the quantified amplitude, relative spectral power （RSP） , 95% spectral edge frequency （SEF） were recorded. Results Among 24 patients, 90.5% （76/84） versus 76.2% （64/84） of all RASS assessments reached light sedation in group Dex compared with group Pro （P〈0.05）. All amplitude-integrated EEG（aEEG） showed normal amplitude of background activity. There were no statistically significant differences in the upper and lower marginof amplitude between the two groups （P〉O.05）. The RSP in group Dex were significantly higher than that in group Pro and the RSP were reversed （P〈0.05）. The 95% spectral edge frequency （SEF, Hz） in group Pro was significantly higher than that in group Dex （P〈0.05）. Conclusion Light sedation rate is higher in patients sedated by dexmedetomidine. In light sedation, the δ RSP was higher in group Dex and the β RSP was higher in group Por. The light sedative effect of dexmedetomidine is better than that of propofol.