The Clinical Study Of Antagonism Of Stress And Stress Ulcer Of Closed Loop Of Target Controlled Infusion Feedback On Severe Patients In Intensive Care Unit

Objective:To study the sedation effect of target controlled infusion with Propofol and Bispectral Index on Severe Patients in Intensive Care Unit, and study its prophylaxis effect on stress response or stress ulcer developed in these patients, with a appropriate sedation level under the ideal BIS.Method:30 patients underwent the acute physiology and chronic health evaluation (APACHE II), with APACHEⅡ≥16, were randomly divided into three groups:GroupⅠwas contrasting group, use propofol for sedation,and fentanyl for controlling pain with micro pump infusion, attempting to keep the patients' Ramsay score in the range from 2 to 4; Group II was the group of Propofol with TCI for sedation,and fentanyl with micro pump infusion for controlling pain, attempting to keep the patients' Ramsay score in the range from 2 to 4; GroupⅢwas the group of Propofol with CLTCI which target scope of BIS value was set from 80 to 70 for sedation, and fentanyl with micro pump infusion for controlling pain. HR and MAP were monitored before infusion,12hours after infusion and 24 hours after infusion; venous blood samples were taken during these time, and the concentration of GLU, COR and ACTH were measured each time; Gastric fluids were taken and PH were measured each time.Result:GLU, COR and ACTH were decreased obviously in three groups after sedation therapy(in 24 hours) (P<0.05). PH in gastric fluids were gradually increased over time in three groups after sedation therapy(in 24 hours), have significant difference compare to the data collected before infusion(P<0.05). GLU, COR, ACTH and PH in gastric fluids have no significant difference in groupⅡand groupⅢ, compared to groupⅠ(P>0.05). MAP and HR have no significant difference before and after infusion in groupⅠ(in 24 hours); MAP in three groups all have decreased slightly (P<0.05) and have no significant difference (P>0.05) compared to the fundamental figures after infusion; BR,HR and SPO2 have no significant difference before and after infusion in all three groups (in 24 hours)(P>0.05)Conclusion:1. Effective sedation and analgesia therapy can relieve the stress response, increase PH in gastric fluids, decrease the risks and prevent the development of stress ulcer in critical patients. 2. Compared to the traditional continuing infusion methods and TCI, CLTCI technique can provide more stable haemodynamic, increase the flexibility and controllability of sedation and effectively avoid the suppression of the cardiovascular system.