目的 探讨光谱熵评估缺血性脑卒中患者镇痛镇静治疗效果的可靠性及可行性.方法 选取 2021 年 7 月至 2022 年11月牡丹江医学院附属红旗医院收治的 64 例急性缺血性脑卒中患者为研究对象,根据随机数字表法将纳入患者分为对照组和实验组,每组各 32 例.对照组患者根据Richmond躁动镇静量表(Richmond agitation-sedation scale,RASS)评分、重症监护疼痛观察工具(critical-care pain observation tool,CPOT)评分结果调整镇痛镇静方案,实验组患者根据光谱熵结果调整镇痛镇静方案.比较两组患者的生命体征、C 反应蛋白(C-reactive protein,CRP)、镇静镇痛用药剂量和不良反应发生率.光谱熵值与RASS评分、CPOT评分的相关性采用Spearman相关分析.结果 实验组患者的光谱熵值与RASS评分、CPOT 评分均呈正相关(r=0.719、0.556,P<0.001).两组患者不同时点的平均动脉压、经皮动脉血氧饱和度比较差异均无统计学意义(P>0.05).实验组患者T3时点的心率显著低于对照组(P<0.05).T1、T2、T3时,实验组患者的CRP水平均显著低于对照组(P<0.05).实验组患者舒芬太尼和咪达唑仑的用量均显著少于对照组(P<0.05).实验组患者的不良反应发生率显著低于对照组(12.50%vs.34.38%,χ2=4.267,P=0.039).结论 光谱熵可作为监测缺血性脑卒中患者镇痛镇静深度的一种客观方法,与RASS评分、CPOT评分具有较好的相关性,可降低不良反应发生率,有效避免应激反应,减少镇痛镇静药物的应用.
Objective To investigate the reliability and feasibility of spectral entropy in evaluate the effectiveness of analgesic sedation in patients with ischemic stroke.Methods A total of 64 patients with acute ischemic stroke admitted to Hongqi Hospital Affiliated to Mudanjiang Medical University from July 2021 to November 2022 were selected as study objects,and the included patients were divided into control group and experimental group according to random number table method,with 32 cases in each group.Patients in control group adjusted analgesia and sedation regimen according to Richmond agitation-sedation scale(RASS)score and critical-care pain observation tool(CPOT)score.Patients in experimental group adjusted the analgesic and sedation regimen according to the results of spectral entropy.The vital signs,C-reactive protein(CRP),dose of sedative and analgesic drugs and incidence of adverse reactions were compared between two groups.The correlation between spectral entropy and RASS score and CPOT score was used Spearman correlation analysis.Results The spectral entropy values were positively correlated with the RASS score and CPOT score,respectively(r=0.719,0.556,P<0.001).There were no significant differences in mean arterial pressure and percutaneous arterial oxygen saturation between two groups at different time points(P>0.05).The heart rate at T3 in experimental group was significantly lower than that in control group(P<0.05).At T1,T2 and T3,CRP levels in experimental group were significantly lower than those in control group(P<0.05).The dosage of sufentanil and midazolam in experimental group were significantly lower than those in control group(P<0.05).The incidence of adverse reactions in experimental group was significantly lower than that in control group(12.50%vs.34.38%,χ2=4.267,P=0.039).Conclusion Spectral entropy can be used as an objective method to monitor the depth of analgesia and sedation in patients with ischemic stroke,and has a good correlation with RASS score and CPOT score,which can reduce the incidence of adverse reactions,effectively avoid stress reactions,and reduce the application of analgesia and sedation drugs.
刘成仁;谢凤杰;郭永波;崔轮盟;李婉玉
牡丹江医学院第一临床学院,黑龙江牡丹江 157011牡丹江医学院附属红旗医院重症医学科,黑龙江牡丹江 157011牡丹江医学院基础医学院,黑龙江牡丹江 157011
临床医学
光谱熵;缺血性脑卒中;镇痛;镇静
Spectral entropy;Ischemic stroke;Analgesia;Sedation
《中国现代医生》 2024 (001)
28-31 / 4
黑龙江省牡丹江市应用科技研究与开发计划项目(HT2022NS108)
10.3969/j.issn.1673-9701.2024.01.007
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