麻醉指数与Narcotrend指数监测小儿扁桃体/腺样体切除术中麻醉深度一致性的对比分析

Comparative analysis of the consistency of anesthesia depth between anesthesia index and Narcotrend index in monitoring pediatric tonsillectomy/adenoidectomy surgery

目的分析麻醉指数(AI)与Narcotrend指数(NI)监测小儿扁桃体/腺样体切除术中麻醉深度的一致性。方法前瞻性纳入2022年7月至2023年10月空军军医大学附属西京医院接受择期扁桃体/腺样体切除术的患儿129例。所有患儿入手术室后均同时采用ConView监测仪进行AI监测,采用Narcotrend监测仪进行NI监测,采用丙泊酚-瑞芬太尼复合全凭静脉麻醉,术中调节麻醉药物剂量,使NI维持在40~60。记录患儿安静闭眼时(T_(1))、诱导开始时(T_(2))、意识消失时(T_(3))、气管插管时(T_(4))、手术开始(T_(5))、扁桃体切除(T_(6))、腺样体刮除(T_(7))、手术结束(T_(8))、意识恢复(T_(9))、气管拔管(T_(10))10个时间点的AI及NI。采用Bland-Altman一致性分析评价AI和NI两种麻醉深度监测结果的一致性。采用受试者工作特征(ROC)曲线及曲线下面积(AUC)分析AI及NI对患儿意识状态的预测效能。在术后24 h、术后1周及1个月进行术中知晓情况随访。结果129例患儿中,男78例,女51例,年龄为(7.2±3.2)岁,手术时间为(72.8±14.0)min。AI数据无缺失,NI数据缺失13项,缺失率为10.1%(13/129)。在T_(1)~T_(10)时间点的AI为67.5±19.2,NI为67.2±19.2,Bland-Altman一致性分析结果显示,AI与NI差值为0.3(95%CI:-0.1~0.6,P=0.120),一致性范围外占比4.0%(51/1290)。患儿进行麻醉诱导前,AI和NI均维持在较高水平;随着麻醉诱导开始,患儿意识消失,AI和NI均逐渐降低;停止泵注麻醉药后,AI和NI均逐渐升高,二者在围手术期各个阶段变化趋势一致,且两组数据各时间点比较差异均无统计学意义(均P>0.05)。ROC曲线分析结果提示,AI预测意识状态的cut-off值为72.5,AUC为0.73(95%CI:0.70~0.75),NI预测意识状态的cut-off值为79.5,AUC为0.74(95%CI:0.72~0.77),两种指数的AUC差异无统计学意义(P=0.310)。所有患儿均无术中知晓的发生。结论AI和NI均可用于小儿扁桃体/腺样体切除术中麻醉深度的监测,准确性较高。

Objective To analyze the consistency of the anesthesia index(AI)and Narcotrend index(NI)in monitoring the depth of anesthesia in pediatric tonsil/adenoidectomy.Methods A total of 129 children who underwent elective tonsil/adenoidectomy at Xijing Hospital Affiliated to Air Force Medical University from July 2022 to October 2023 were prospectively enrolled.Both AI monitoring by ConView monitor and NI monitoring by Narcotrend monitor were conducted for children after they were admitted to the operating room,while Propofol-remifentanil combined with total intravenous anesthesia was used during the operation and the anesthetic dose was adjusted to maintain the NI value at 40-60.In addition,the AI and NI values were recorded at following time points:quiet eyes closing(T_(1)),the beginning of induction(T_(2)),loss of consciousness(T_(3)),tracheal intubation(T_(4)),the beginning of surgery(T_(5)),during tonsil excision(T_(6)),adenoidectomy(T_(7)),the end of surgery(T_(8)),consciousness recovery(T_(9))and tracheal extubation(T_(10)).Bland-Altman consistency analysis was used to evaluate the consistency of the results of the two types of anesthesia depth monitoring,AI value and NI value.Receiver operator characteristic(ROC)curve and area under curve(AUC)were used to analyze the predictive efficacy of AI and NI values for the state of consciousness of children.The intraoperative awareness was followed up at 24 hours,1 week and 1 month after surgery.Results In 129 cases,there were 78 boys and 51 girls,with an average age of(7.2±3.2)years and an operation time of(72.8±14.0)min.No AI data were missing,but 13 NI data were missing,with a missing rate of 10.1%(13/129).At time points T_(1)-T_(10),the AI values were 67.5±19.2 and the NI values were 67.2±19.2.Bland-Altman consistency analysis showed that the difference in value between AI and NI was 0.3(95%CI:-0.1-0.6,P=0.120),with an out-of-consistency range of 4.0%(51/1290).Before anesthesia induction,AI and NI values were maintained at a high level;with the beginning of anesthesia induction and the disappearance of the children′s consciousness,both AI and NI values gradually decreased;after discontinuing the infusion of anesthetics,the values of AI and NI gradually increased,and the change trend of AI and NI in each stage of the perioperative period was consistent,and there was no significant difference between the two groups at each time point(all P>0.05).ROC curve analysis showed that the cut-off value for predicting the state of consciousness using AI was 72.5,with an AUC of 0.73(95%CI:0.70-0.75),and the cut-off value of NI was 79.5 and the AUC was 0.74(95%CI:0.72-0.77).There was no significant difference in AUC between the two indices(P=0.310).None of the children had intraoperative awareness.Conclusion Both AI and NI can be used to monitor the depth of anesthesia in pediatric tonsil/adenoidectomy with high accuracy.