不同镇静水平在重型颅脑外伤中效果评估  

Influence of different sedation depth on therapeutic effects for severe traumatic brain injury patients

作　　者：费小斌[1] 龚凯[1] 周新民[1] 孙枢文 高恒[1] FEI Xiaobin;GONG Kai;ZHOU Xinmin(Department of Neurosurgery,the Affiliated Jiangyin Hospital,School of Medicine,Southeast University,Jiangyin 214400,China)

机构地区：[1]东南大学医学院附属江阴医院神经外科,江阴214400

出　　处：《临床神经外科杂志》2023年第5期561-565,共5页Journal of Clinical Neurosurgery

基　　金：无锡市科技局科研立项项目(CSE31N1521)。

摘　　要：目的探讨脑电双频指数(BIS)指导下不同镇静程度对重型颅脑外伤患者治疗效果的影响。方法共纳入江阴市人民医院神经外科2015年10月—2016年12月收治的37例重型颅脑外伤患者,并分为镇静程度评估表(RASS),BIS(Ⅰ)和BIS(Ⅱ)组。将RASS组的镇静水平控制在-2或-3范围内,BIS(Ⅰ)和(Ⅲ)组分别控制在40~50和50~60范围内。除了收集临床资料外,需每30 min采集RASS,BIS和颅内压(ICP)值。采用RASS和ICP变异值,通过统计学分析对比不同监测手段和不同镇静水平控制效果。结果3组患者一般资料无显著差异(P>0.05)。BIS(Ⅰ)和(Ⅱ)组的RASS变异值显著低于RASS组(P<0.05),BIS(Ⅰ)组则显著低于BIS(Ⅱ)组(P<0.05)。BIS(Ⅰ)和(Ⅱ)组ICP值较RASS组更早降至13.5 mmHg以下(P<0.05),而该值在BIS(Ⅰ)和(Ⅱ)组间差异不显著。RASS组的ICP变异值显著高于BIS(Ⅰ)和(Ⅱ)组(P<0.05),BIS(Ⅰ)组的ICP变异值显著低于BIS(Ⅱ)组(P<0.05)。三组患者在NICU治疗时间差异不显著。结论在镇静水平的监测和维持上,BIS较RASS可靠,镇静水平维持40~50能促进ICP在低变异的基础上有效降低。Objective To investigate the influence of different sedation depth guided by the bispectral index(BIS)on the therapeutic effects for severe traumatic brain injury(TBI).Methods Totally 37 patients with severe traumatic brain injury(sTBI)admitted to Department of Neurosurgery,the Affiliated Jiangyin Hospital from October 2015 to December 2016 were included and divided into Richmond agitation sedation scale(RASS),BIS(Ⅰ)and BIS(Ⅱ)groups.RASS group was controlled the level of sedation to within-2 or-3,and the BIS(Ⅰ)and(Ⅱ)groups within the range of 40 to 50 and 50 to 60,respectively.RASS,BIS and intracranial pressure(ICP)values were collected,in addition to clinical data.RASS and ICP variability were introduced to investigate the different of sedative control effect with or without BIS monitor,and the control effect of ICP between different sedation levels.Statistical analysis was performed to estimate the effectiveness of different sedation levels guided by BIS in sedation treatment within 72 hours.Results There were no significant differences in demographics among three groups(P>0.05).RASS variability of BIS(Ⅰ)and(Ⅱ)groups were significant lower than RASS group's(P<0.05),and BIS(Ⅰ)group were insignificantly lower than BIS(Ⅱ)group.ICP of BIS(Ⅰ)and(Ⅱ)groups declined to below 13.5 mmHg significantly earlier than RASS group's(P<0.05),and difference between BIS(Ⅰ)and(Ⅱ)was insignificant.ICP variability of RASS group was higher than those of BIS(Ⅰ)and(Ⅱ)groups(P<0.05),and ICP variability of BIS(Ⅰ)group was significantly lower than BIS(Ⅱ)group(P<0.05).Differences in NICU stay and outcomes among three groups were insignificant.Conclusions BIS is more reliable than RASS for maintaining a stable sedation status and ICP.Deeper sedation levels(BIS 40-50)cause ICP to drop more quickly with lower ICP variability.

关 键 词：创伤性脑损伤 镇静 脑电双频指数 镇静程度评估表 颅内压 

分 类 号：R651[医药卫生—外科学]