Narcotrend与BIS监测硬膜外阻滞期间右美托咪定镇静深度的比较

Comparation of Narcotrend and BIS monitoring during sedation with dexmedetomidine under epidural anesthesia

目的探讨右美托咪定(Dex)作为硬膜外阻滞辅助用药时Narcotrend与BIS监测镇静深度的相关性及一致性。方法选择16例拟行硬膜外麻醉患者,ASAⅠ或Ⅱ级,硬膜外阻滞效果确切后,经静脉持续输注Dex负荷量0.5μg/kg,15min输完,继以0.4μg·kg-1·h-1恒速泵入维持至术毕。同时行BIS、Narcotrend麻醉/脑电意识深度监测,每隔1分钟成对记录二者的监测值,分析相关性及一致性。记录镇静深度判断显著错误(即BIS与Narcotrend监测结果差异显著)的次数,Ⅰ型错误:BIS<40而Narcotrend指数(NTI)>64或BIS65～40而NTI>94;Ⅱ型错误:BIS>85而NTI<65或BIS85～65而NTI<13。结果 NTI与BISSpearman相关系数r=0.856(P<0.01)。加权κ=0.70(P<0.01)。Bland-Altman分析:NTI与BIS的比值均数为0.99;一致性界限为(0.77,1.20);61对(4.72%)的点在95%一致性界限以外;一致性界限范围内,比值最大值为1.197,最小值为0.769。镇静深度判断显著错误发生率19对(1.47%),其中Ⅰ型错误发生率为3对(0.23%),Ⅱ型错误发生率为16对(1.24%)。结论 Narcotrend与BIS监测镇静深度的相关性及一致性较高,均可用于硬膜外麻醉期间Dex镇静水平的评价。

Objective To explore Narcotrend with BIS monitoring during dexmedetomidine （Dex） as an adjuvant under epidural anesthesia. Methods Sixteen patients scheduled for epidural anesthesia,ASA I or Ⅲ were prospectively studied. After an induction of epidural anesthesia,a Dex loading close was administered at 0.5 μg/kg in 15 rain, followed by a continuous infusion at 0.4 μg.kg 1 , h-1. BIS and Narcotrend were monitored simultaneously, and both values were recorded every minute. The correlation between BIS and Nareotrend Index （NTI）was tested by Spearman correlation analysis. All data were compared by Bland Altman analysis and weighted Kappa coefficient for agreement. And the number of significant misjudgment on sedative depth （i. e., significant differences between BIS and Narcotrend monitoring） was counted,Type I misjudgement was defined as BIS〈40 and NTIS64 or BIS 65 40 and NTI〉94;Type Ⅱ was defined as BIS〉85 and NTIS65 or BIS 85-65 and NTI〈13. Results BIS and NTI Spearman correlation coefficient r 0. 856（P〈0.01）. The weighted Kappa coefficient （κ）=0.70（P〈0.01）. The mean ratio of NTI and BIS was 0.99;95% limits of agreement was（0.77,1.20）;4.72 % （61/1293）of the point were outside the 95 % limits of agreement; within the limits of agreement, maximum ratio was 1. 197, minimum value was 0. 769. The incidence of significant misjudgment on sedative depth was 1.47%（19/1293）, among them type I was 0. 23%（3/1293） , type Ⅱ was 1.24% （16/1293）. Conclusion There are significantly positive correlation and agreement between Narcotrend and BIS, and both of them are adapt to monitor the deoth of sedation in Dex under epidural anesthesia.