| Objective To explore the feasibility of Narcotrend index?NTI?for digital monitoring of light sedation depth in patients undergoing short-term mechanical ventilation after pancreaticoduodenectomy.Methods A prospective randomized controlled trial was conducted.87 patients with mechanical ventilation for 12-48 hours after pancreaticoduodenectomy admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Wannan Medical College from January 2016 to December 2018 were enrolled.They were randomly divided into Narcotrend Index?NTI?group and Richmond Agitation-Sedation Score?RASS?group.Narcotrend index and Richmond agitation-sedation score were used to guide light sedation treatment respectively.The implementation effect of light sedation,mechanical ventilation time,dosage of sedative drugs,occurrence of adverse events?accidental extubation,occurrence of delirium,cardiovascular events?and stress response hormone levels?cortisol,epinephrine,norepinephrine,c-reactive protein?were compared between the two groups.Results A total of 87 patients were enrolled in this study,of which 45 received NTI-guided sedation assessment and 42 received RASS-guided sedation assessment.There was no significant difference in age,sex,BMI,liver function classification,operation time,blood loss,conversion to laparotomy and APACHE?score between the two groups.During sedation treatment,the light sedation compliance rate and cumulative compliance period number?Dt?in D1,D2 and D3 periods in NTI group are higher than those in RASS group?D1:71.11%?32/45?vs.50%?21/42?,D2:80%?36/45?vs.54.76%?23/42?,D3:88.89%?40/45?vs.59.52%?25/42?.Dt:83.92%?642?vs.62.83%?475?,all P<0.05.?The dosage of dexmedetomidine in NTI group was higher than that in RASS group(ug.kg-1.h-1:0.60±0.10 vs.0.54±0.12),but more patients in RASS group added a larger dose of propofol to maintain sedation[Propofol:64.29%?27/42?vs.37.78%?17/45?,mg.h-1,47.82±7.31 vs.30.83±10.35,all p<0.05).the sedation duration and mechanical ventilation time in NTI group were lower than those in RASS group?h:15.68±2.43 vs.17.29±2.43,16.27±2.42 vs.18.25±2.04,all p<0.05?.There was no significant difference in hypertension,bradycardia,accidental extubation and delirium after extubation between the two groups during sedation treatment,but the incidence of hypotension in RASS group was higher than that in NTI group[35.71%?15/42?vs.13.33%?6/45?].Compared with RASS group,the levels of epinephrine,norepinephrine and C-reactive protein at T3 and T5 points in NTI group are lower[epinephrine?pg/L?:T3:138.35±18.60 vs 157.50±19.91,T5:136.24±40.40 vs150.46±20.22,norepinephrine?pg/L?:T3:347.34±45.46 vs 393.75±49.77,T5:340.59±50.95 vs 376.37±49.70,c-reactive protein?ng/ml?:T3:62.26±18.78 vs71.31±10.32,T5:53.30±14.47 vs 64.26±14.69,all p<0.05),cortisol level at T3 was lower than that of RASS group?ng/ml:327.03±41.04 vs 358.12±70.01?.Conclusions The application of Narcotrend index monitoring to guide light sedation therapy for patients with short-term mechanical ventilation after pancreaticoduoden-ectomy can better achieve the goal of light sedation. |
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