早期处理后脑电图用于深度镇静及机械通气危重患者监测  

Early Processed Electroencephalography for the Monitoring of Deeply Sedated Mechanically Ventilated Critically Ill Patients

作　　者：张守文 付佳郁 高路盈 ZHANG Shouwen;FU Jiayu;GAO Luying(Department of Neuroelectrophysiology,Beijing Dawanglu Emergency Hospital,Beijing,100122)

机构地区：[1]北京大望路急诊抢救医院神经电生理科,北京100122

出　　处：《山西大同大学学报(自然科学版)》2025年第1期67-69,82,共4页Journal of Shanxi Datong University(Natural Science Edition)

摘　　要：目的通过处理后脑电图(p-EEG)检测深度镇静的急性器官衰竭危重患者的患者状态指数(PSI),并评估低PSI值(<25)与ICU意识错乱评估方法(CAM-ICU)评估的谵妄之间的关系。方法研究对象为97例急性器官衰竭患者。在最初的72 h治疗期间,使用SEDLine脑功能监测仪监测患者PSI;使用重症监护病房意识模糊评估方法(CAM-ICU)评估谵妄。根据ICU中有无谵妄,将患者分为谵妄(n=41)组和无谵妄组(n=56)。采用多元逻辑回归分析ICU中谵妄发生的影响因素。结果与无谵妄组相比,谵妄组患者镇静阶段接受的芬太尼和丙泊酚总剂量较高,而且昏迷时间、机械通气时间及ICU住院时间均延长(P<0.05)。与无谵妄组患者相比,谵妄组患者PSI<25比例较高(P<0.05)。针对镇痛和镇静的累积剂量进行校正后,PSI<25时间增加与较高的谵妄发生率相关(OR=1.017,95%CI=1.021~1.229,P=0.033)。结论早期深度镇静时,PSI<25比例较高可能与谵妄发生相关。PSI靶向镇静是否有助于减少镇静剂量和谵妄值得临床进一步研究。Objective Patient Status Index(PSI)was measured by processed electroencephalography(p-EEG)in deeply seaged critically ill patients with acute organ failure,and the association between low PSI values(<25,to define an EEG depression state)and delirium as assessed by the Confusion Assessment.Methods for the Intensive Care Unit(CAM-ICU)was assessed.Method The subjects of this study were 97 patients with acute organ failure in our hospital.The Patient State Index(PSI)was monitored with the SEDLine monitor during the first 72 hours of treatment.Delirium was assessed using the CAM-ICU.According to the presence or absence of delirium in the ICU,the patients were divided into delirium group(n=41)and non-delirium group(n=56).Multivariate logistic regression was used to analyze the influencing factors of delirium in ICU.Results Compared with the non-delirium group,the total doses of fentanyl and propofol during sedation were higher,and the duration of coma,mechanical ventilation and ICU stay were longer in the delirium group(all P<0.05).Compared with the non-delirium group,the delirium group had a higher percentage of time with PSI<25(P<0.05).After adjustment for the cumulative doses of analgesia and sedation,an increase in time with PSI<25 was associated with a higher incidence of delirium(OR=1.017,95%CI=1.021~1.229,P=0.033).Conclusion During early deep sedation,a higher percentage of time with PSI<25 may be associated with the occurrence of delirium.Whether PSI-targeted sedation can help reduce sedation dose and delirium deserves further clinical investigation.

关 键 词：重症监护 谵妄 脑电图 患者状态指数 

分 类 号：R741.04[医药卫生—神经病学与精神病学]