脑电双频指数反馈控制下的咪达唑仑闭环靶控输注在ICU镇静中的临床研究

Midazolam closed-loop Target Controlled Infusion with Bispectral Index Feedback Control in ICU Sedation

目的:探讨脑电双频指数(Bispectral index,BIS)反馈控制下的咪达唑仑闭环靶控输注(Closed-loop target controlled infusion,CLTCI)在重症加强护理病房(Intensive Care Unit,ICU)镇静中的临床应用价值。方法:选取2015年1月至2016年12月在湖北医药学院附属随州医院ICU住院治疗的120例患者作为研究对象,均通过输注咪达唑仑进行镇静,随机分为A组40例采用微量泵连续输注、B组40例采用靶控输注(Target controlled infusion,TCI)、C组40例采用闭环靶控输注(CLTCI),均进行入院24h内APACHEⅡ评分,记录镇静前HR、RR、MAP、BIS以及镇静效果等数据并进行比较。结果:与MAP、HR基础值相比较,三组患者镇静后MAP均明显下降,但无统计学意义(P>0.05);三组患者不同Ramsay评分所对应的BIS值呈负相关(相关系数r=-0.856),随着镇静深度的加深三组患者BIS值均明显下降,其中3分、4分、5分、6分所对应的BIS值显著低于1分所对应的BIS值,4分、5分、6分所对应的BIS值显著低于2分所对应的BIS值,均具有统计学意义(P<0.05);三组维持理想镇静时间百分比、达到60~80范围BIS值时间百分比以及24h咪达唑仑平均用量之间比较差异显著,均具有统计学意义(P<0.05);C组维持理想镇静时间百分比与达到60~80范围BIS值时间百分比显著高于A组、B组,C组24h咪达唑仑平均用量显著少于A组、B组,均具有统计学意义(P<0.05)。结论:与采用微量泵连续输注和TCI输注方式相比较,CLTCI在维持镇静效果的同时还可有效减少咪达唑仑的用量,值得临床推广应用。

Objective： To analyze the application value of midazolam CLTCI with BIS feedback control in ICU sedation. Methods： 120 patients admitted in ICU of Suizhou Affiliated Hospital to Hubei Medicine University from January 2015 to December 2016 selected as the research objects,were randomly divided into group A of 40 cases using micro pump continuous infusion,group B of 40 patients with target controlled infusion,（ target controlled,infusion,TCI） group C of 40 cases using the closed-loop target controlled infusion（ CLTCI） and APACHE were performed within 24 h after admission II score. The data of HR,RR,MAP before sedation,BIS and sedation effect were recorded and compared. Results： Compared with the basic values of MAP and HR,the MAP of three groups decreased obviously after sedation,but there was no statistical significance（ P〈0.05）; The BIS values corresponding to the different Ramsay scores were negatively correlated in the three groups（ correlation coefficient,r =-0.856）. With the depth of sedation,BIS values of patients in three groups were significantly decreased. Among them,the BIS value corresponding to 3 points,4 points,5points and 6 branches was significantly lower than the corresponding BIS value of the 1 branche. The corresponding BIS values of 4 points and 6 branches were significantly lower than the corresponding BIS values of the 2 branches,all of which were statistically significant（ P〈0.05）. The corresponding values of the 5 branches were statistically significant（ P 0）; There was significant difference between the three groups in maintaining ideal sedation time,60 - 80 range,BIS value,time percentage and average dosage of midazolam in24 h,and statistically significant（ P〈0. 05）; Group C maintain ideal sedation time and the percentage reached 60 - 80 BIS value of the percentage of time was significantly higher than that of group A,group B,group C 24 h,the average amount of midazolam significantly less than group A and group B were statistically significant（ P〈0. 05）. Conclusions： Compared with the continuous infusion and TCI infusion,the CLTCI can effectively reduce the dosage of midazolam while maintaining sedation,and it is worthy of clinical application.