镇痛镇静评估张中伟.pptVIP

记录两组病人镇静前、镇静达标时、达标后6小时、12小时及18小时的指标。 生理指标：心率、血压、呼吸频率、SPO2、血气分析及计算氧合指数。 镇静指标： Ramsay评分、SAS评分及BIS值。 四川大学华西医院ICU, 2004.10 BIS监测对ICU机械通气患者镇静深度评估的研究 恰当的镇静治疗不会对机械通气病人基本生理指标造成异常影响。 利用BIS监测意识状态和镇静深度与Ramsay评分、SAS评分比较，具有较好的一致性。 BIS与Ramsay评分、SAS评分之间存在较好的相关性。 BIS=80时，诊断的敏感性和特异性适当，准确率较高。保持BIS≤80，能够得到一个比较适度的镇静水平。 四川大学华西医院ICU, 2004.10 结论 Patient State Index The PSI, displayed on the Sedline Monitor (Hospira, Lake Forest, IL, USA), is another approach to quantifying cerebral cortical activity. scale from 0 to 100 that reflects the depth of sedation of the patient. The scale is updated every 1.2 seconds, which makes this monitor quick to respond to changes in cerebral cortical activity. It was validated in a large database of patients and volunteers . The Cerebral State Index (CSI) In a comparative study, both the BIS and the CSI had a predictive probability statistic for depth of anesthesia of 0.87, which demonstrates good performance. The CSI performed better for deeper levels of anesthesia than the BIS, which was better at lighter levels. This Entropy Monitor This Auditory Evoked Potential monitor ---the Alaris Auditory Response Index (AAI?) 推 荐 镇静的客观评价方法例如BIS在ICU的临 床资料有限，作为C级推荐。 Jacobi J, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med. 2002 Jan;30(1):119-41. 危重病人的谵妄 80%的ICU病人会出现谵妄症状 谵妄的特点 精神状态突然改变或波动 注意力不集中 思维紊乱 意识状态改变 伴有或不伴有躁动 谵妄病人的临床表现 白天醒觉状态波动，睡眠清醒周期失衡或白天夜晚睡眠周期颠倒 情绪过于低沉，或过于兴奋，或两者兼有 情绪低沉型谵妄：表情安静、呆滞，注意力不集中，活动减少。往往预后差 情绪活跃型谵妄：言语激动、攻击行为、定向力差，给予镇静剂后出现精神错乱 Trzepacz PT. Psychiatr Clin North Am. 1996;19:429-49. Meagher DJ, et al. Semin Clin Neuropsychiatry 2000;5:75-85. CAM-ICU的敏感性为93-100%，特异性98-100%，具有高度可靠性(k=0.96)，平均实施时间2+/-1min 推 荐 ICU应常规进行谵妄评估。CAM-ICU是对 ICU病人进行谵妄评估的可靠方法(B级) Jacobi J, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med. 2002