量化镇静在高血压脑出血患者术后早期平稳过渡中的应用研究

doi:10.3969/j.issn.1002-1949.2019.11.005

Chinese Journal of Critical Care Medicine

Application research of quantitative sedation monitoring for patients with intracerebral hemorrhage in the early stage of post-operation

Zhong Xian-liang, Shan Ai-jun, Xie Man-ying, Liang Jian, Zhong Yuan-bo, Xu Jian-zhong, Du Bo

Department of Emergency, the Second Clinical College of Jinan University(Shenzhen People′s Hospital), Shenzhen 518020, China

Abstract
Figure/Table
References (26)
Related Citation (15)

Download: PDF (0 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To observe the clinical efficacy of quantitative sedation monitoring for hypertension intracerebral hemorrhage(HICH) patients in the early stage of post-operation using historical controlled study． Methods To compare and analyze the sedative use, the rebleeding incidence of post-operation, the ICU staying time and the infection incidence of pulmonary between the quantitative sedation group (58 cases)during 2017-02～2019-02 and the control group(58 cases)during 2015-01～2017-02 patients after sedative stopping using in 24 hours． Results The time of ventilator with drawal （h:6.4±1.8 vs. 15.2±2.2, P=0.00）, the amount of sedative use ［μg/(kg·h):62.4±4.9 vs. 90.7±8.8，P=0.00］，the ICU staying time（d：6.2±1.3 vs. 9.4±1.6, P=0.01）the infection incidence of pulmonary (12.1% vs. 25.9%, P=0.02) in the quantitative sedation group were better than those of the control group. The rebleeding incidence of post-operation was no statistical difference between the two groups (3.4% vs. 5.2%, P=0.34)． Conclusion Quantitative sedation monitoring on patients with HICH after craniotomy in the early stage of post-operation can significantly reduce the amount of sedative use; promote the ventilator with drawal and shorten the ICU staying time.This is a conducive method to help patients with HICH go through the early stage after operation smoothly．

Key words： Hypertension Intracerebral hemorrhage Sedation Analgesia Cerebral state index (CSI)

Corresponding Authors: Du Bo, E-mail: ftipa@163.com

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Zhong Xian-liang
	Shan Ai-jun
	Xie Man-ying
	Liang Jian
	Zhong Yuan-bo
	Xu Jian-zhong
	Du Bo

Cite this article:

Zhong Xian-liang,Shan Ai-jun,Xie Man-ying, et al. Application research of quantitative sedation monitoring for patients with intracerebral hemorrhage in the early stage of post-operation[J]. Chinese Journal of Critical Care Medicine, 2019, 39(11): 1036-1039.

URL:

http://www.cnemergency.org.cn/EN/10.3969/j.issn.1002-1949.2019.11.005 OR http://www.cnemergency.org.cn/EN/Y2019/V39/I11/1036

［1］Manno EM, Atkinson JL, Fulgham JR, et al. Emerging medical and surgical management strategies in the evaluation and treatment of intracerebral hemorrhage［J］. Mayo Clin Proc, 2005, 80(3): 420-433. ［2］Puntillo KA, Max A, Timsit JF, et al. Determinants of procedural pain intensity in the intensive care unit: The Europain study［J］. Am J Respir Crit Care Med, 2014, 189(1): 39-47. ［3］Arboix A. Hypertension and the acute phase of intracerebral haemorrhage: more evidence of the ′silent killer′［J］. Eur J Neurol, 2018, 25(8): 1007-1008. ［4］Thabet AM, Kottapally M, Hemphill JC, et al.Management of intracerebral hemorrhage［J］. Handb Clin Neurol, 2017, 140: 177-194. ［5］Godoy DA, Nunez-Patino RA, Zorrilla-Vaca A, et al. Intracranial hypertension after spontaneous intracerebral hemorrhage: A systematic review and meta-analysis of prevalence and mortality rate［J］. Neurocrit Care, 2019, 31(1): 176-187. ［6］Hinkelbein J, Lamperti M, Akeson J, et al. European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults［J］. Eur J Anaesthesiol, 2018, 35(1): 6-24. ［7］Green SM, Roback MG, Kennedy RM, et al. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update［J］. Ann Emerg Med, 2011, 57(5): 449-461. ［8］Kalil AC, Metersky ML, Klompas M, et al. Executive summary: management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the infectious diseases society of America and the American thoracic society［J］. Clin Infect Dis, 2016, 63(5): 575-582. ［9］Torres A, Niederman MS, Chastre J, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociacion Latinoamericana del Torax (ALAT) ［J］. Eur Respir J, 2017, 50(3):1700582. ［10］单爱军, 古美华, 丁兆义, 等. 脑损害昏迷患者脑状态实时监测的研究及应用［J］.中华创伤杂志, 2006, 22(7):486-489. ［11］Jensen EW, Litvan H, Revuelta M, et al. Cerebral state index during propofol anesthesia: a comparison with the bispectral index and the A-line ARX index［J］. Anesthesiology, 2006, 105(1): 28-36. ［12］杜波，彭玉平，钟贤良，等.神经内镜通道内技术治疗重度脑室内出血的研究［J］. 中国急救医学, 2016, 36(9): 799-803. ［13］杜波，单爱军，王进，等.重度脑室内出血尿激酶溶栓单双管引流效率比较［J］. 中国急救医学, 2014, 34(4): 323-326. ［14］杜波，单爱军，李超，等.神经内镜内技术治疗亚急性-慢性和慢性分隔硬膜下血肿的临床研究［J］. 中国急救医学, 2018, 38(8): 654-659. ［15］Zhang YJ, Shan AJ, Peng YP, et al. The intra-neuroendoscopic technique (INET): a modified minimally invasive technique for evacuation of brain parenchyma hematomas［J］. World J Emerg Surg, 2019, 14: 21. ［16］Du B, Shan AJ, Peng YP, et al. A new modified neuroendoscope technology to remove severe intraventricular haematoma［J］. Brain Inj, 2018, 32(9): 1142-1148. ［17］Du B, Wang J, Zhong XL, et al. Single versus bilateral external ventricular drainage for intraventricular fibrinolysis using urokinase in severe ventricular haemorrhage［J］. Brain Inj, 2014, 28(11): 1413-1416. ［18］Jackson DL, Proudfoot CW, Cann KF, et al. The incidence of sub-optimal sedation in the ICU: a systematic review［J］. Crit Care, 2009, 13(6): R204. ［19］Dong R, Li F, Xu Y, et al. Safety and efficacy of applying sufficient analgesia combined with a minimal sedation program as an early antihypertensive treatment for spontaneous intracerebral hemorrhage: a randomized controlled trial［J］. Trials, 2018, 19(1): 607-611. ［20］Owen GD, Stollings JL, Rakhit S, et al. International analgesia, sedation, and delirium practices: a prospective cohort study［J］. J Intensive Care, 2019, 142(7): 25-29. ［21］Strom T, Toft P. Sedation and analgesia in mechanical ventilation［J］. Semin Respir Crit Care Med, 2014, 35(4): 441-450. ［22］Erstad BL, Puntillo K, Gilbert HC, et al. Pain management principles in the critically ill［J］. Chest, 2009, 135(4): 1075-1086. ［23］Tsai CJ, Chu KS, Chen TI, et al. A comparison of the effectiveness of dexmedetomidine versus propofol target-controlled infusion for sedation during fibreoptic nasotracheal intubation［J］. Anaesthesia, 2010, 65(3): 254-259. ［24］Buhl R, Barth H, Mehdorn HM. Risk of recurrent intracerebral hemorrhages［J］. Neurol Res, 2003, 25(8): 853-856. ［25］Vidale S, Pini C, Arnaboldi M. Blood pressure control and recurrence of intracerebral hemorrhage［J］. JAMA, 2016, 315(6): 611. ［26］Haller JT, Wiss AL, May CC, et al. Acute management of hypertension following intracerebral hemorrhage［J］. Crit Care Nurs Q, 2019, 42(2): 129-147.