摘要
目的总结丙泊酚和咪达唑仑单独及复合靶控输注(target-contolled infusion,TCI)时维持 ICU 患者适度镇静的效应部位靶浓度,寻找适合 ICU 患者长时间镇静的合理用药方案,探讨 BIS 指数(bispectral index,BIS)与危重患者镇静评分的相关性。方法选择综合 ICU 患者60例,随机分为3组,A 组和 B 组分别单独靶控输注丙泊酚和咪达唑仑镇静,C 组在背景靶控输注效应室靶浓度30ng/ml 咪达唑仑的基础上,输注一定靶浓度的丙泊酚。记录各组患者在不同 RASS 镇静评分(richmond agitation-sedation scale)时的药物效应部位靶浓度、BIS 指数和生命体征变化以及维持8 h 适度镇静的用药量、不良事件发生率和苏醒时间。结果 A 组和 C 组维持患者适度镇静(RASS=-2～-3)的丙泊酚效应室靶浓度在分别为(1.26±0.19)～(1.52±0.18)μg/ml 和(0.50±0.95)～(1.01±0.24)μg/ml。B 组维持适度患者镇静的咪达唑仑效应室靶浓度为(97.05±14.51)～(134.75±9.66)ng/ml。患者适度镇静时对应的 BIS 值为(66.10±2.52)～(71.05±1.45)。停药后苏醒时间 B 组明显长于其他两组(P<0.05),A、C 组无明显区别;再睡眠率也以 B 组最高(P<0.05);低血压、恶心呕吐发生率3组无明显区别(P>0.05)。C 组维持8 h 适度镇静所需咪达唑仑和丙泊酚的用量均较单一用药组明显减少(P<0.05)。BIS 值与RASS 评分呈正相关,总的(n=60)相关系数为0.93(P<0.01)。结论(1)丙泊酚-咪达唑仑复合靶控可成倍减少单一用药量,在降低应用成本的同时避免了单一用药的缺点,保留了各自优点,是 ICU 长时间镇静的理想用药。(2)BIS 指数与主观镇静评分有较好的相关性,可用于指导 ICU 的镇静治疗。
Objective To investigate the predicted drug effective site concentration of propofol or midazolam making patients reach proper levels of sedation when either of these two drugs was used soley or administered synchronously in the way of TCI. To observe the correlation between BIS （ bispectral index） and sedation scale. Methods 60 patients in ICU were randomly divided into three groups; propofol group （group A ） , midazolam group （group B ） and propofol midazolam group（ group C）. We observed the predicted drug effective site concentration. BIS and life sign of the patients involved in these three groups at different RASS （ The richmond agitation-sedation scale）. The recovery time, total dosage in 8 hours and the incidence of undesired reaction of the three administration methods were compared too. Results In group A the effective site concentration of propofol to keep the patient at ideal sedation level（ RASS - 2 - - 3 ） was 1.26 ± 0. 19 - 1.52 ± 0. 18 ug/ml and it was 0. 50 ±0. 95 ug/ml to 1.01 ±0. 24 ug/ml in group C. In group B,the effective site concentration of midazolam was 97. 05 ± 14. 51 - 134. 75 ± 9. 66 ng/ml to make the patients at this sedation level. The eorresponsive BIS was 66. 10 ± 2. 52 - 71.05 ± 1.45 when patients was at ideal sedation level. Among the three groups, the recovery time was similar between the group A and group C, but it was longer in group B than the other groups （ P 〈0.05 ）. The rate of sleeping again is higher in group B（ P 〈0.05）. There was no significant different on the rate of the hypotension and nausea among this three groups（ P 〈 0. 05 ）. In the group C, the total dosage of the two sedatives to maintain the proper sedation level within 8 hours was reduced dramatically in contrast to the other two groups（ P 〈 0. 05 ）. Positive eorelation was proved between RASS and BIS, the coefficient of correlation was 0. 93 to all of the patients （ n = 60, P 〈 0. 01 ）. Conclusion （ 1 ） In these three administration methods,
出处
《临床急诊杂志》
CAS
2008年第4期220-224,共5页
Journal of Clinical Emergency
