监测脑电双频谱指数预防全麻患者术中知晓的效果：meta分析

Efficacy of bispectral index monitoring for prevention of intraoperative awareness in patients under general anesthesia： a meta-analysis

目的采用meta分析评价脑电双频谱指数（BIS）监测用于预防全麻患者术中知晓的效果。方法检索Cochrane Central Register of Controlled Trials（Central）、Pubmed、Medline、EMBASE等数据库有关BIS监测与未应用BIS监测全麻患者术中知晓效果的临床、随机、对照研究。应用Cochrane协作网系统评价法对纳入文献质量进行评价和资料提取，评价指标为术中知晓发生率。采用RevMan5．1软件进行meta分析。结果共纳入5项研究，包括34181例患者，其中应用BIS监测患者17432例，术中知晓发生率0．132％；未应用BIS监测患者16749例，术中知晓发生率0．245％，BIS监测组与未应用BIS监测组术中知晓发生率比较差异无统计学意义（P〉0．05）；根据麻醉方式不同进一步分析：在吸人麻醉中，应用BIS监测患者13288例，术中知晓发生率0．128％，未应用BIS监测患者13202例，术中知晓发生率0．113％，BIS监测组与未应用BIS监测组术中知晓发生率比较差异无统计学意义（P〉0．05）；在全凭静脉麻醉中，应用BIS监测患者4144例，术中知晓发生率0．145％，未应用BIS监测患者3547例，术中知晓发生率0．733％，BIS监测组术中知晓发生率明显低于未应用BIS监测组（P〈0．01）。结论监测BIS可预防全凭静脉麻醉患者术中知晓的发生，但不能预防吸入麻醉患者术中知晓的发生。

Objective To systematically review the efficacy of bispectral index （BIS） monitoring for pre- vention of intraoperative awareness in patients under general anesthesia. Methods The Cochrane Central Register of Controlled Trials （Central）, PubMed, Medline, and EMBASE were searched for randomized controlled clinical trials involving detection of intraoperative awareness in patients in whom BIS was used or not under general anesthe- sia. The quality of the studies was evaluated by the method recommended by Cochrane Collaboration. Evaluation indexes included the incidence of intraoperative awareness. Meta-analysis was conducted using RevMan 5.1 soft- ware. Results Five randomized controlled clinical trials involving 34181 patients were included in this meta-analy- sis. There were 17432 cases in whom BIS was applied and the incidence of intraoperative awareness was 0.132%. There were 16749 cases in whom BIS was not used and the incidence of intraoperative awareness was 0.245%. There was no significant difference in the incidence of intraoperative awareness between the two groups （ P 〉 0.05）. Further analysis was performed according to the method of anesthesia. In inhalational anesthesia, there were 13288 cases in whom BIS was applied and the incidence of intraoperative awareness was 0. 128%, and there were 13202 cases in whom BIS was not applied and the incidence of intraoperative awareness was 0.113%. There was no significant difference in the incidence of intraoperative awareness between the two groups （P 〉 0.05）. In total intravenous anesthesia, there were 4144 cases in whom BIS was applied and the incidence of intraoperative awareness was 0. 145 %, and there were 3547 cases in whom BIS was not applied and the incidence of intraopera- tive awareness was 0.733%. The incidence of intraoperative awareness was significantly lower in the patients in whom BIS was applied than those in whom BIS was not applied （ P 〈 0.01 ）. Conclusion BIS monitoring can ef- fectively prevent the development of intraoperative awareness in patients under total intravenous anesthesia, but can not prevent the development of intraoperative awareness in patients under inhalational anesthesia.