脑电双频指数对结核ICU有创机械通气患者镇静效果评估

Evaluation of the Sedative Effect of Bispectral Index of Electroencephalogram on Patients with Invasive Mechanical Ventilation in Tuberculosis ICU

摘要: 目的：评估脑电双频指数(BIS)监测应用于结核病重症监护室(ICU)接受有创机械通气患者时，对比传统镇静评估方法，能否在提升镇静管理精确性、控制药物使用及改善患者安全预后方面发挥显著作用。方法：本研究实施了一项随机对照试验。于2024年6月至2025年12月，纳入成都市某传染病院结核ICU中符合标准、需行有创机械通气的患者60名，借助随机数字表法将之分为两组。干预组(30例)接受基于BIS数值(目标值65~84)与里士满躁动镇静量表(RASS)评分的双重镇静调控；对照组(30例)仅依据RASS评分(目标值0至−2)进行镇静管理。所有患者均采用咪达唑仑方案实施镇静。对比分析的主要指标涉及镇静目标实现耗时、目标维持稳定性(24小时达成率)、镇静药物消耗总量，以及非计划性拔管、低血压、谵妄等不良事件发生率。次要指标包括机械通气时长、ICU住院时间等。结果：数据显示，干预组达到预设镇静水平所需的时间显著短于对照组。在维持阶段，干预组患者处于理想镇静状态的时间比例更高，同时其咪达唑仑的平均使用量更低。安全性层面，干预组发生非计划性拔管的病例数明显少于对照组。然而，两组患者在低血压、心动过缓和谵妄的发生情况上未体现统计差异。临床转归上，干预组患者的平均机械通气时间和ICU停留天数均较对照组有所缩短。结论：对于结核ICU内的机械通气患者，在RASS主观评估基础上辅以BIS客观监测，能够实现更灵敏、更精准的镇静深度调控。该策略不仅可以加速镇静目标的达成并增强其维持的稳定性，减少镇静药物的需求量，还可能有效降低如非计划性拔管等关键风险事件的发生概率，从而为优化此类患者的整体镇静管理方案提供了新的实践依据。

Abstract: Objective: To evaluate whether the application of bispectral index (BIS) monitoring in the intensive care unit (ICU) for patients receiving invasive mechanical ventilation with tuberculosis can significantly improve the accuracy of sedation management, control the use of drugs, and enhance the safety prognosis of patients compared to traditional sedation assessment methods. Methods: This study conducted a randomized controlled trial. From June 2024 to December 2025, 60 patients meeting the criteria and requiring invasive mechanical ventilation in the tuberculosis ICU of a certain infectious disease hospital were included. Using the random number table method, they were divided into two groups. The intervention group (30 cases) received dual sedation regulation based on BIS values (target range 65~84) and the Richmond Agitation-Sedation Scale (RASS) score; the control group (30 cases) only received sedation management based on the RASS score (target range 0 to −2). All patients received midazolam for sedation. The main indicators for comparison analysis included the time required to achieve the preset sedation level, the stability of the target level (24-hour achievement rate), the total consumption of sedative drugs, and the incidence of unplanned extubation, hypotension, delirium, etc. Secondary indicators included the duration of mechanical ventilation, ICU stay time, etc. Results: The data showed that the time required for the intervention group to reach the preset sedation level was significantly shorter than that of the control group. During the maintenance stage, the proportion of patients in the intervention group in an ideal sedation state was higher, and the average usage of midazolam was lower. In terms of safety, the number of cases of unplanned extubation in the intervention group was significantly less than that in the control group. However, there was no statistical difference in the occurrence of hypotension, bradycardia, and delirium between the two groups. Clinically, the average duration of mechanical ventilation and ICU stay time of the intervention group were shorter than those of the control group. Conclusion: For patients receiving invasive mechanical ventilation in the tuberculosis ICU, supplementing BIS objective monitoring on the basis of RASS subjective assessment can achieve more sensitive and precise sedation depth regulation. This strategy can not only accelerate the achievement of sedation goals and enhance their stability, reduce the demand for sedative drugs, but also effectively reduce the probability of key risk events, such as unplanned extubation, thereby providing a new practical basis for optimizing the overall sedation management plan for such patients.