闭袢靶控输注用于ICU病人镇静及对氧耗的影响  

Close-Loop Feedback Controlled Infusion of Propofol and Midazolam with BIS for Sedation and Their Effect on Oxygen Consumption

作　　者：嵇富海[1] 张光明[1] 诸杜明[1] 梁雅芬[1] 薛张刚[1] 蒋豪[1] 

机构地区：[1]复旦大学附属中山医院麻醉科,上海200032

出　　处：《复旦学报（医学版）》2004年第5期484-487,共4页Fudan University Journal of Medical Sciences

摘　　要：目的　观察以脑电双频指数 (BIS)作为反馈控制信号的闭袢靶控输注 (CLTCI)异丙酚和咪唑安定的镇静效果、及对氧耗 (V·O2 )的影响。方法　 32例机械通气的病人 ,随机分为两组 :异丙酚组 (P组 )和咪唑安定组 (M组 ) ,每组 16例 ,P组以BIS作为反馈信号的CLTCI异丙酚进行镇静 ,M组采用CLTCI咪唑安定进行镇静。连续监测血压、心率、呼吸、脉搏血氧饱和度、V·O2 的变化 ,记录BIS、Ramsay评分、诱导时间及异丙酚、咪唑安定诱导剂量、总用量、苏醒时间及不良反应 ,并评价CLTCI系统的性能。结果　完全苏醒时间P组明显短于M组 (P <0 .0 5 )。Ramsay与BIS呈正相关 ,Ramsay、BIS与靶控血浆浓度和效应室浓度呈负相关。M组wobble明显较大 (P <0 .0 5 )。两组镇静期间V·O2 明显低于镇静前 ,组间比较无明显差别 (P >0 .0 5 % )。结论　以BIS作为反馈控制信号的CLTCI异丙酚和咪唑安定技术用于ICU病人镇静 ,其效果可靠、性能稳定、除可降低氧耗外。Purpose: This was an exploratory study evaluating the performance of Close-loop feedback control system by which a appropriate sedation level was achieved with propofol Vs with midazolam in postoperative patients admitted in medical intensive care unit. Methods: A total of 32 patients requiring mechanical ventilatory support was eligible for this study. For prospective trial, propofol group (group P, n = 16) and midazolam group (group M, n = 16) were divided randomly in equal number of patients. Patients were sedated with propofol using close-loop control system guided by a Bispectral Index (BIS) in group P. Initially, a loading dosage of propofol was administered at a given target plasma concentration of 1.5 μg/mL. This target was manually increased or reduced in a stepwise by 0.5 μg/mL increment or decrement concentration every minute until the sedation target (Ramsay score 3) was reached. Just at this desired sedation level, the BIS value was taken as a set-point for feedback then initiated in the closed-loop control system. In group M patients were sedated with midazolam using the same system. With the given target plasma concentration of 100 ng/mL and the target concentration was adjusted upward or downward by 50 ng/mL increment or decrement concentration every minute in the same manner. BP, HR, BIS, Ramsay score and VO2 were recorded every five minutes. Induction time, induction dosage and total dosage, target concentrations and adverse side effect were noted. The performance of CLTCI was evaluated. Results: No patient became hemodynamically unstable while sedated. The performance characteristics of the system, were excellent. But the wobble of group M was greater than that of group P (P 2 was comparable to that of midazolam. Conclusions: To sedate patients with propofol or midazolam using close loop control system guided by the Bispectral Index was safe and efficient in the medical intensive care unit. The effect of propofol on the oxygen consumption of patients was parallel to that of midazolam.

关 键 词：镇静 咪唑安定 异丙酚 氧耗 ICU病人 靶控输注 BIS 性能稳定 降低 可靠 

分 类 号：R614[医药卫生—麻醉学] R971[医药卫生—外科学]