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

Object:To study the Stress Effects by different bispectral index-closed loop-target contrlled infusion for mechanical ventilation patients; To compare the effects between different bispectral index-closed loop-target controlled infusion with Propofol on sedation of ICU critical illness patients,and search the best bispectral index.Method:Sixty critical patients undergoing mechanical ventilation in ICU which the APACHEⅡ(Acute physiology And Chronic Health EvaluationⅡ, APACHEⅡ) scores>16 points were Randomly divided into three groups:Target scope of BIS value of GroupⅠ(Control group, n=20) were set from 55 to 65, GroupⅡ(Experimental group, n=20) were set from 65 to 75and the groupⅢ(Experimental group, n=20)75 to 85. Sedative, analgesic treatments with closed loop of target controlled infusion of propofol (Target scope of BIS value were different) and micro pump infusion of fentanyl were all used in each group. Interruption sedation twice a day was all used in each group. MAP, RR, SPO2, HR value, the Ramsay score and the corresponding value of BIS monitoring were observed and recorded per 1 hour; Finger blood glucose monitoring once every 4h; detecting the serum COR, ACTH concentration and Ph value of gastric acid at 0h(T0),12h(T1),24h(T2); And the total amount of propofol in 24h were recorded too.Result:The correlation was proved between BIS values and Ramsay scores to each group (rs=-0.901, P<0.05); BIS values of GroupⅠin the range of 55 to 65, the time percentage was 78.60%, BIS values of GroupⅡin the range of 65 to 75 was 81.20% and GroupⅢin the range of 75 to 85 was 78.00%;There were no significant differences in targeted range of BIS values among three groups. Three groups on the dosage of propofol had significant difference (P＜0.05),and the dosage of propofol of GroupⅠwas most. There were no significant difference at the time points (T0, T1, T2) in the values of MAP in groupⅢ(P＞0.05); There were significant differences at the time points (T1, T2) in the values of MAP among the three groups(P＜0.05); In groupⅠand groupⅡ,the values of MAP decreased, T1 to T0, T2 to T1, had significant difference (P＜0.05). There were no significant difference at the time points (T0, T1, T2) in the values of HR in and between groupⅡwithⅢ(P＞0.05); In groupⅠ, the values of HR decreased, groupⅠto groupⅡ, groupⅠto groupⅢ, had significant difference (P＜0.05); There were significant difference at the time points (T1, T2) in the values of HR comparing with the basic values(T0) in groupⅠ(P＜0.05);In groupⅠ,T2 to T1, had no significant difference(P＞0.05). There were no significant difference at the time points (T0, T1, T2) in the values of RR in and between groupⅡwithⅢ(P＞0.05); In groupⅠ, the values of RR decreased, groupⅠto groupⅡ, groupⅠto groupⅢ, had significant difference (P＜0.05); There were significant difference at the time points (T1, T2) in the values of RR comparing with the basic values(T0) in groupⅠ(P＜0.05); In groupⅠ,T2 to T1, had no significant difference (P＞0.05). There were no significant difference in the values of SPO2 comparing with the basic values in each group (P＞0.05) and no significant difference among three groups. There were no significant difference in the values of ACTH comparing with the basic values in groupⅢ(P＞0.05); In groupⅠ, the values of ACTH decreased firstly(T1) and then increased (T2), T1 to T0, T2 to T1, had significant difference (P＜0.05), and T2 to T0, had no significant difference (P＞0.05); The ACTH of groupⅡdecreased and had significant difference between T2 with T0 (P＜0.05). There were no significant difference in the values of COR comparing with the basic values in groupⅢ(P＞0.05); There were significant difference at the time points (T1, T2) in the values of COR comparing with the basic values(T0) in groupⅠandⅡ(P＜0.05), and T2 to T1, had no significant difference (P＞0.05); There were no significant difference between groupⅠandⅡ(P＞0.05);In groupⅢ,the values of COR decreased too slowly, groupⅢto groupⅠ,groupⅢto groupⅡ,had significant difference(P＜0.05). The values of blood glucose had no significant difference among three groups (P＞0.05); In the three groups, the values of blood glucose decreased, T1 to T0, T2 to T1, had significant difference (P<0.05),andT1 to T2, had no significant difference (P>0.05). PH in gastric fluids gradually increased over time in three groups, had significant difference compare to the data collected before infusion(P< 0.05); There were no significant difference between groupⅠwith groupⅡ(P>0.05); In groupⅢ, PH in gastric fluids increased too slowly, groupⅢto groupⅠ,groupⅢto groupⅡ,had significant difference(P<0.05).Conclusion:1. Effective sedation and analgesia can relieve the stress response, increase PH in gastric decrease the risks and prevent the development of stress ulcer in critical patients.2. The correlation was proved between BIS values and Ramsay scores.3.The BIS values range of 55 to 85 can meet the requirement of sadation on severe patients in the intensive care unit.It shoud be choice the "individuation" sedation proposal according to ICU critical illness patients'different condition.4. Compared to the effects between different bispectral index-closed loop-target controlled infusion with Propofol on sedation of ICU critical illness patients, in the BIS values range of 65 to 75, CLTCI can provide more stable haemodynamic, can relieve the stress response and effectively avoid the suppression of the cardiovascular system.