Narcotrend指数对重症患者机械通气镇静治疗的效果评估

Application of Narcotrendindex in sedation assessment inseverepa-tients with mechanical ventilation

目的评估Narcotrend指数对重症患者机械通气镇静治疗的效果。方法选择2018年4月—2020年4月在鄂州市中心医院诊的重症患者机械通气患者68例,采用随机数字法将患者分为两组,A组、B组,各34例,A组给予Narcotrend指数(narcotrend index,NTI)指导镇静治疗,B组给予Richmond躁动-镇静评分(richmond agitation and sedation scale,RASS)进行镇静指导,分析两组患者镇静效果、镇静药物用量、机械通气时间、应激反应及不良事件。结果A组患者治疗后2 h、4 h、6 h、拔管前镇静达标率及累计镇静达标率均高于B组患者(P<0.05);A组患者联合使用丙泊酚率、丙泊酚用量、机械通气时间、镇静持续时间均低于B组,右美托咪定用量高于B组(P>0.05);治疗后6 h、导管拔除后2 h,两组C-反应蛋白、去甲肾上腺素、肾上腺素、血皮质醇均低于治疗前(P<0.05);治疗后6 h、导管拨出后2 h,A组C-反应蛋白、去甲肾上腺素、肾上腺素、血皮质醇均低于B组(P<0.05)A组患者总不良事件发生率明显低于B组患者(P>0.05)。结论Narcotrend指数在指导重症患者机械通气镇静治疗中效果较好,能明显减少患者丙泊酚用量及使用率与机械通气时间、持续镇静时间、应激反应及不良事件发生率。

Objective To investigate the value of Narcotrend index(NTI)in sedation assessment incritically illpatients with mechanical ventilation.Methods To investigate the value of Narcotrend index(NTI)in sedation assessment in criti⁃cally ill patients with mechanical ventilation.MethodsSixty-eight critically ill patients with mechanical ventilation in Ezhou Central Hospital were selected,andequally divided into two groups by random number table methods.During the sedation,group A received NTI guidance,while group B received Richmond agitation-sedation score(RASS)guidance.The sedative effect,dosage of sedative drugs,mechanical ventilation time,stress reaction and adverse events were com⁃pared between groups.Results The light sedation compliance ratebefore tracheal catheter removal and the cumulative compliance rate at post-treatment 2,4,and 6 hourswere all significantly higher in group A than in group B(all P<0.05).Compared with group B,group A had lower rate of propofoluse,smaller dosage of propofol,as well as shorter duration of mechanical ventilation andsedation,meantime,the dosage of dexmedetomidine was significantly higher in group A than in group B(all P>0.05).There was a decrease in the levels of C-reactive protein,norepinephrine,epinephrine,and blood cortisol of both groups at 6 hours after treatment and 2 hours after catheter removal(all P<0.05),and the decrease was more obvious in group A than in group B(all P<0.05).The incidence of adverse events in group A was lower than that in group B,with no statistical difference(P>0.05).Conclusion NTIis of great value in guiding sedation treatment of severe patients with mechanical ventilation,which can significantly reduce the dosage and utilization rate of propo⁃fol,shorten the duration of mechanical ventilation and continuous sedation,and decrease the incidence of stress reac⁃tion and adverse events.