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目的利用量化脑电图(q EEG)观察右美托咪定和丙泊酚镇静治疗对机械通气患者浅镇静水平脑电活动的影响,评价两种药物的镇静效果。方法选择2016年4-10月入住中山大学附属第一医院重症加强治疗病房(ICU)需镇痛镇静治疗超过24 h的机械通气成人患者24例,随机分为右美托咪定组(Dex组)和丙泊酚组(Pro组),每组12例。在充分镇痛的基础上,Dex组持续泵入右美托咪定1μg/(kg·h),Pro组持续泵入丙泊酚3 mg/(kg·h),并根据镇静深度调整药物用量,维持Richmond躁动-镇静评分(RASS)在-2~1分的浅镇静目标。分别于给药0、5、15、30 min和1、12、24 h进行RASS评分。镇静开始后持续q EEG监测1 h,随后于12 h和24 h各监测30 min,选取浅镇静时的脑电信号进行2 min采样,记录波幅、相对频带能量(RSP)、95%边缘频率(SEF)等量化参数。结果两组患者24 h内各进行了84次RASS评估,Dex组和Pro组分别有76次(90.5%)和64次(76.2%)RASS评分达浅镇静目标,差异有统计学意义(P<0.05)。所有入组患者治疗24 h内振幅整合脑电图均属于正常脑电背景活动;两组振幅上、下边界差异均无统计学意义(P>0.05)。Dex组δ波RSP高于Pro组,β波RSP低于Pro组,差异均有统计学意义(P<0.05)。Pro组95%SEF高于Dex组,差异有统计学意义(P<0.05)。结论右美托咪定的浅镇静达标率更高,浅镇静状态下右美托咪定引起的δ波频带能量更高,丙泊酚引起的β波频带能量更高,右美托咪定的浅镇静效果优于丙泊酚。
Objective To observe the effects of dexmedetomidine and propofol sedation on the light-level electroencephalogram (EEG) in patients with mechanical ventilation by quantitative electroencephalogram (qEEG) and to evaluate the sedation effect of the two drugs. METHODS: Twenty-four adult patients with mechanical ventilation admitted to ICU in the First Affiliated Hospital of Sun Yat-sen University from April to October in 2016 were randomly divided into Dexmedetomidine group (Dex group, ) And propofol group (Pro group), 12 cases in each group. On the basis of adequate analgesia, the Dex group was continuously pumped into dexmedetomidine 1 μg / (kg · h), while the Pro group was continuously pumped with propofol 3 mg / (kg · h), and the dosage of the drug was adjusted according to the sedation depth , To maintain the Richmond Restlessness - Sedation (RASS) light calm target of -2 to 1 minutes. RASS scores were administered at 0, 5, 15, 30 min and 1, 12, 24 h, respectively. After the onset of sedation, qEEG monitoring was continued for 1 h, then monitored at 12 h and 24 h for 30 min. Sham-operated EEG signals were taken for 2 min and the amplitude, relative band energy (RSP), 95% edge frequency ( SEF) and other quantitative parameters. Results Eighty-four RASS assessments were performed within 24 h in both groups, with 76 (90.5%) and 64 (76.2%) RASS scores in the Dex and Pro groups, respectively, reaching the goal of light sedation, with a statistically significant difference (P < 0.05). All patients underwent amplitude-integrated electroencephalogram (EEG) within 24 hours after treatment. All of them were normal EEG background activities. There was no significant difference between the upper and lower amplitude of the two groups (P> 0.05). The RSP of δ wave in Dex group was higher than that of Pro group, while the RSP of β wave was lower in Pro group than in Pro group (P <0.05). 95% SEF in Pro group was higher than Dex group (P <0.05). Conclusions Dexmedetomidine has a higher incidence rate of light sedation, a higher δ wave frequency band caused by dexmedetomidine in shallow sedation, a higher β wave frequency band caused by propofol and a lower dexmedetomidine Shallow calm effect is better than propofol.