重度颅脑损伤术后撤机拔管中BIS监测的预测价值

Predicting value of BIS in weaning of severe craniocerebral injury patients after surgery

目的：探讨脑电双频指数（BIS）监测在重度颅脑损伤术后撤机拔管中的预测价值。方法：选择52例重度颅脑损伤术后拟撤机拔管患者（GCS 5~8分）,所入选患者术后全部符合经验性撤机拔管指征,拔管前行BIS监测,所有入组患者根据BIS值分为低分组（BIS〈60分,n=19）和高分组（BIS≥60分,n=33）。比较两组撤机拔管成功率、再插管率、肺部感染发生率、入组两周后GCS评分、1个月后GOS预后评分。结果：BIS高分组脱机拔管成功率明显高于低分组,低分组再插管率高于高分组,两者之间差异有统计学意义（P〈0.05）。低分组患者肺部感染发生率高于高分组,两者之间差异有统计学意义（P〈0.05）。治疗两周后高分组GCS评分高于低分组,1个月后GOS评分高分组高于低分组,两组比较差异有统计学意义（P〈0.05）。结论：在经验性撤机拔管的基础上应用BIS监测值作为撤机拔管的预测指标,能够提高重度颅脑损伤患者术后撤机拔管成功率,对患者预后有一定评估作用。

Objective： To study the predicting value of bispectral index（ BIS） in weaning of severe craniocerebral injury patients after surgery. Methods： 52 cases of patients after the operation with severe craniocerebral injury were selected,these patients were all removed of the ventilator and extubated（ GCS 5-8）. All the patients were in conformity with the empirical standard of removal of the ventilator and extubation. BIS monitoring was applied to the removal of tracheal intubation. The patients were divided into two groups according to the scores of BIS,the high score group（ 33 cases） and the low score group（ 19 cases）. Greater than or equal to 60 of BIS value was divided into the high score group,less than 60 for the low score group. The success rate with removal of the ventilator and extubation,frequency of again into the tracheal intubation,the incidence of pulmonary infection,the GCS score two weeks later,the GOS one month later were compared in the two groups. Results： The success rate of removal of the ventilator and extubation of the high score group was significantly higher than that of the low score group. Again insertion frequency of tracheal intubatio on the low score group was higher than that of the high score group. There was a statistically significant difference between the two groups（ P 0. 05）. Incidence of pulmonary infection of the low score group was higher than that of the high score group. There was a significant difference between the two groups（ P 0. 05）,After two weeks,the GCS score of the high score group was higher than that of the low score group,and the score of GOS was higher than that of the low score group after one month（ P 0. 05）. Conclusions：In the removal of the ventilator and endotracheal tube on the empirical criterion,The monitoring value of BIS as a predictor for weaning and extubation can improve ventilator and extubation success rate for severe craniocerebral injury patients. The monitoring values of BIS have a certain effect on the predicting prognosis of the patients.