脑电双频指数的早期目标导向镇静在ICU重症患者镇静管理中的应用

Application of early goal-directed sedation with bispectral index in sedation management of severe patients in ICU

目的将脑电双频指数(BIS)引入ICU重症患者镇静策略并替代Richmond躁动镇静评分(RASS),对比实行早期目标导向镇静(EGDS)和标准化镇静(STDS)的两组患者的机械通气时间、住ICU时间以及90 d死亡率。方法前瞻性对照研究住ICU机械通气≥48 h的重症患者(2016年4月至2017年5月20例、2017年6月至2018年4月32例),均分别随机分为EGDS组及STDS组;分析第一时间段两组患者的RASS与BIS的相关性,得出EGDS组患者达到RASS-2~1时的BIS为73.65±7.87,STDS组患者达到RASS-3^-1时的BIS为64.14±7.25;以上述BIS为导向分别运用于第二时间段内的两组患者镇静策略中,记录两组的机械通气时间、住ICU时间以及90 d死亡率。结果两组患者机械通气时间差异无统计学意义[(164.12±137.96) h vs (155.33±64.86) h,P=0.08],EGDS组的住ICU时间长于STDS组(P<0.05),EGDS组的90 d死亡率高于STDS组(P<0.05)。结论 BIS与RASS有较好的相关性,能用于住ICU患者的镇静评估;引入BIS的EGDS与STDS的比较,仍需大样本研究。

Objective The bispectral index (BIS) was introduced into the sedation strategy of critical patients in intensive care unit (ICU) and replaced the Richmond agitation sedation scale (RASS).The ventilation time,ICU length of stay,and 90-day mortality were compared between the two groups of patients who performed early goal-directed sedation (EGDS) or standard traditional directed sedation (STDS) strategies.Methods A prospective controlled study of severe patients with mechanical ventilation ≥48 h in ICU (20 cases from April 2016 to May 2017,46 cases from June 2017 to April 2018) were randomly divided into EGDS or STDS group.There were no significant differences in age,gender,and acute physiology and chronic health evaluation scoreⅡ(APACHE Ⅱ) score between the two groups in the two periods.The correlation between RASS and BIS was analyzed in the first period.The BIS of the patients in a RASS range of (-2-1) was 73.65±7.87 in the EGDS group,and that of RASS range of (-3--1) was 64.14±7.25 in the STDS group.The above BIS was applied to the two sedation strategies in the second period respectively.The ventilation time,ICU length of stay,and 90-day mortality were recorded.Results There was no significant difference in the ventilation time between the two groups [(164.12±137.96)h and (155.33±64.86)h,P=0.08].ICU length of stay of the EGDS group was longer than that of the STDS group.The 90-day mortality of the EGDS group was higher than that of the STDS group.Conclusions Correlations between RASS and BIS were found in this study,and BIS can be used for sedation assessment in ICU patients.Large sample study is still needed to compare EGDS and STDS with BIS.