麻醉深度指数与脑电双频谱指数监测镇静深度的比较

Comparison of Cerebral State Index and Bispectral Index for Assessment of Sedation Depth during TCI of Propofol and Remifentanil

目的:比较麻醉深度指数(CSI)与脑电双频指数(BIS)监测异丙酚-瑞芬太尼麻醉患者镇静深度的准确性。方法:择期全麻手术患者44例,ASAⅠ或Ⅱ级,年龄18～60岁,体质量指数20～30kg/m2,随机分为R0、R2、R4、R6组,每组11例。R0组麻醉诱导时靶控输注(TCI)生理盐水,R2、R4、R6组分别以效应室靶浓度2、4、6μg/L TCI瑞芬太尼,10min后TCI异丙酚,初始异丙酚效应室靶浓度均为1.5mg/L,每4min增加0.5mg/L,改良警觉/镇静(OAA/S)评分为1分时给予强直刺激,直到患者对刺激出现有意识的反应消失为止。记录患者的CSI和BIS,每间隔20s行改良OAA/S评分,记录TCI系统预测效应部位浓度值每变化0.1mg/L时的数值和时间。计算CSI和BIS预测不同改良OAA/S评分的预测概率(Pk)。结果:4组患者CSI及BIS与改良OAA/S评分均有较好的相关性,4组患者CSI及BIS在不同改良OAA/S评分时的镇静深度均表现出较高的Pk值(Pk>0.85)。4组患者睫毛反射消失及强直刺激消失时的CSI50小于BIS50。结论:CSI与BIS一样能够较好地反映异丙酚-瑞芬太尼麻醉患者镇静深度的变化。

Objective： To evaluate the accuracy of cerebral state index （CSI） and bispectral index （BIS） by measuring the sedation depth during target-controlled infusion （TCI）of propofol and remifentanil.Methods： Forty-four patients （ASA Ⅰ or Ⅱ ） aged 18-60 years undergoing elective surgery under general anesthesia were randomly divided into 4 groups （n=11, each） according to the target effect-site concentration of remifentanil administered by TCI during induction of anesthesia （0,2,4,6 μg/L）.The electrodes of BIS and CSI were placed according to the instruction manuals before induction of anesthesia. The anesthesia was induced with TCI of remifentanil and propofol. The initial effect-site propofol concentration was 1.5 mg/L and was increased by 0.5 mg/L every 4 min.The values of BIS and CSI were continuously monitored and recorded. OAMS score （5= alert, 1 = does not respond to prodding） was recorded every 20 seconds. Spearman correlation coefficient between OAA/S score and BIS and CSI and their prediction probabilities （Pk） were calculated. CSI50, BIS50, Ce50 at loss of eyelash reflex（LOR eyelash） and at loss of response to electric tetanic stimulation（LOR tetanic） were also calculated.Results ：The 4 groups were comparable with respect to age and bodyweight.CSI and BIS correlated well with sedation depth. There Was no significant difference in the prediction probability between CSI and BIS. The values of BIS50 were higher than that of CSI50 in all four groups respectively, Conclusion ： During TCI of propofol and remifentanil both CSI and BIS can be used to accurately measure the sedation depth.