Dissertation > Excellent graduate degree dissertation topics show

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

Author: YangYaoPeng
Tutor: QianChuanYun；WangYunHui；LiuRong；ZhangZuo
School: Kunming Medical College
Course: Intensive medical profession
Keywords: Bispectral Index Closed - loop target controlled infusion Sedation Ramsay score Stress Stress ulcer
CLC: R614
Type: Master's thesis
Year: 2011
Downloads: 25
Quote: 0
Read: Download Dissertation

Abstract

Objective: To investigate the bispectral index (Bispectral Index, BIS) closed loop feedback control target controlled infusion (Closed Loop of Target Controlled Infusion CLTCI) technology of the intensive care unit (Month Intensive Care ICU) mechanical ventilation sedation patients the impact of the stress response; different BIS values ??under closed-loop control, the infusion of propofol for ICU patients control the depth of sedation, and expect to find the optimal ICU sedation BIS values. Method: select 60 cases Check my Division EICU ward of critically ill patients with acute physiology and chronic health status ratings systems (Acute Physiology And Chronic Health Evaluation Ⅱ, APACHE II) score, election APECHE Ⅱ score) larger than 16 points patients were randomly divided into three groups . Each group BIS feedback under closed-loop control of propofol and trace pump infusion of fentanyl sedative, analgesic treatment; BIS values ??of patients in each control within. Groups are daily wake-up secondary. Setting the the group Ⅰ closed target controlled target BIS values ??55 to 65; the group Ⅱ closed loop target controlled target BIS value setting of 65 to 75; Ⅲ group closed loop the target controlled target BIS value is set to 75 to 85. Every 1h recorded mean arterial pressure (MAP), respiratory frequency (RR), pulse oxygen saturation (SP02), heart rate (HR) values ??and Ramsay score and the corresponding BIS monitoring value; once every 4h monitoring finger blood sugar; detection 0h (T0) 12h (T1), 24h (T2) serum cortisol (COR), the to promote adrenal cortex hormone (ACTH) concentration and the PH value of gastric juice; records propofol dosage. Results: selected observational study (n = 60) BIS values ??and Ramsay score has a good correlation (rs = -0.901, P <0.05); the group Ⅰ BIS value in the range of 55-65% 78.60% II group BIS values ??in the range of 65-75 percentage 81.20% the group III BIS value in the range of 75-85% and 78.00%; showed no statistically significant difference (P> 0.05) between the three groups target BIS value percentage group. There is a statistically significant difference (P <0.05) in three groups of propofol dosage the Ⅰ group dosage. Group of MAP change Ⅲ group was no statistically significant difference (P> 0.05); Ⅰ, Ⅱ group T1, T2 at each time point the MAP changes than TO declined, the changes are statistically significant differences (P <0.05); T1 T2 at each time point MAP change I, group II compared with group Ⅲ decreased, the changes are statistically significant differences (P <0.05); T1, T2 at each time point the MAP changes Ⅰ group declined compared with the group Ⅱ change significantly significant difference (P <0.05). HR changes in group Ⅱ, Ⅲ group group group was no statistically significant difference (P> 0.05); Ⅰ group than in the group Ⅱ, group III heart rate decreased, the changes are statistically significant differences (P <0.05); Ⅰ the HR change group T1, T2 at each time point than TO statistically significant differences (P <0.05), while no statistically significant difference (P> 0.05) in group Ⅰ T1, T2 at each time point HR change. Respiratory rate (RR) changes in group Ⅱ, Ⅲ group group group was no statistically significant difference (P> 0.05); Ⅰ group than in the group Ⅱ, Ⅲ group decreased respiratory rate, changes in a statistically significant difference (P <0.05); than group Ⅰ T1, T2 at each time point changes in respiratory rate TO a significant statistical difference (P <0.05), no statistically significant difference (P> 0.05) and the group Ⅰ T1, T2 each time point changes in respiratory rate. The the three groups SPO2 group, the change between the two groups was no significant difference (P> 0.05). No statistically significant difference (P> 0.05); ACTH changes in group Ⅲ group the trend of group Ⅰ group was first decreased and then increased T1 the TO point comparison, and T2 than T1 more statistically significant differences (P <0.05) ; Ⅰ group T2 point compared with TO was no significant statistical difference (P> 0.05); Ⅱ group group ACTH showed a downward trend, T2 point change there is a statistically significant difference (P <0.05) compared with the TO point. No statistically significant difference (P> 0.05); COR change Ⅲ group group group Ⅰ, Ⅱ group T1, T2 at each time point the COR changes than TO declined, there is a statistically significant difference (P <0.05); Ⅰ and group the group Ⅱ T1 no significant change compared with T2; Ⅰ and group Ⅱ group group no statistically significant difference (P> 0.05); Ⅲ group than in the group Ⅰ, group II COR value decline is too slow, the changes are significant statistical difference (P < 0.05). Changes in blood sugar varies among the 3 groups was no statistically significant difference (P> 0.05); the three groups T1, T2 than TO decreased (P <0.05); among the three groups T1 than T2 blood glucose was no significant statistical difference (P> 0.05). Within 24 hours, three groups of gastric pH value gradually increased with time gastric pH value increases within each group there is a statistically significant difference (P <0.05); no significant changes in the juice pH between group Ⅰ and group Ⅱ ( P> 0.05); Ⅲ group than in the group Ⅰ, group II gastric juice pH value increased slowly change there is a statistically significant difference (P <0.05). Conclusion:. Effective sedation of ICU patients, analgesic treatment, patients can reduce the excessive stress can increase the pH of gastric juice, and reduce the risk factors for stress ulcer, thereby preventing the occurrence of stress ulcer . 2.BIS value Ramsay score there is a good correlation. A BIS value range of 3.55 to 85 can meet ICU patients requires sedation, sedation required the patient's condition requirements to implement individualized. The a BIS value range of 4.65 to 75 can be lower in patients with excessive stress, able to maintain relatively stable hemodynamics in patients, and can effectively avoid its inhibitory effect on the cardiovascular system.

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

Abstract

Related Dissertations