脑电双频指数目标导向性镇痛镇静在ICU自发性脑出血患者早期血压管理中的应用

Application of target oriented analgesia and sedation with bispectral index in early blood pressure management for patients with spontaneous intracerebral hemorrhage

目的探讨以脑电双频指数为目标导向的镇痛镇静策略在重症监护病房自发性脑出血患者早期血压管理中的应用。方法将90例需要镇痛镇静治疗的成人自发性脑出血患者随机分为脑电双频指数镇静组(45例)和标准镇静组(45例)。所有受试者均根据病情接受常规治疗,并持续泵入瑞芬太尼0.5~6.0μg/(kg·h)-1镇痛。脑电双频指数镇静组通过适当使用镇静药物使脑电双频指数维持在65~85,标准镇静组Richmond躁动—镇静评分维持在0~2分,镇静药物均使用右美托咪定。2组受试者早期均按需使用乌拉地尔尽可能将收缩压降至110~140 mmHg,并持续维持。比较2组患者治疗过程中收缩压、舒张压、平均动脉压、血压变异率、脑电双频指数、脑组织氧合指数、非语言成人疼痛评估量表评分、机体反应水平分级评分、Richmond躁动—镇静评分量表评分、降压药物用量等的差异。结果脑电双频指数镇静组收缩压变异率、平均动脉压变异率低于标准镇静组(P<0.05);脑组织氧合指数高于标准镇静组(P<0.01),脑电双频指数低于标准镇静组(P<0.01),降压药物用量低于标准镇静组(P<0.05),均差异有统计学意义。结论以脑电双频指数为目标导向的镇痛镇静策略可以使自发性脑出血患者达到与主观镇痛镇静评分相同的镇痛镇静目标,并且血压波动更小,保证更高的脑组织供氧,减少降压药物的使用量。

Objective To explore the application of a target oriented analgesia and sedation strategy based on bispectral index(BI)in the early blood pressure management of patients with spontaneous intracerebral hemorrhage in the intensive care unit.Methods A total of 90 patients with intracerebral hemorrhage needing analgesia and sedation were randomly divided into the bispectral index sedation group(45 cases)and the standard sedation group(45 cases).All subjects received routine treatment according to their condition,and continued to pump Remifentanil 0.5~6.0μg/(kg·h)-1 for analgesia.Patients of the bispectral index sedation group maintained bispectral index at 65~85 through appropriate use of sedative drugs,and Richmond agitation-sedation scale score at 0~2 in the standard sedation group.Dexmedetomidine was used as sedative drugs.In both groups,Urapidil was used as needed in the early stage to reduce the systolic blood pressure to 110~140 mmHg as much as possible and maintain continuously.The differences in systolic blood pressure,diastolic blood pressure,mean arterial pressure,blood pressure variability,bispectral index,brain oxygenation index,nonverbal adult pain assessment scale,reaction level scale,Richmond agitation-sedation scale and antihypertensive drug dosage between the two groups were compared.Results The variability of systolic blood pressure and mean arterial pressure in the bispectral index sedation group were significantly lower than those in the standard sedation group(P<0.05).The brain oxygenation index in the former was significantly higher than in the latter(P<0.01),the bispectral index significantly lower than the latter(P<0.01),and the overall use of antihypertensive drugs significantly lower than in the latter(P<0.05).Conclusions Bispectral index oriented analgesia and sedation strategy can help spontaneous intracerebral hemorrhage patients achieve the same goal as the subjective analgesia and sedation score,and reduce the fluctuation of blood pressure.It ensures higher oxygen supply to brain tissue and reduces the use of antihypertensive drugs.