意识指数对妇科腹腔镜患者麻醉深度监测效果的评价

Evaluation of index of consciousness on anesthesia depth in patients underwent laparoscopy in the Department of Gynecology

目的:评价意识指数的2个监测指标,镇静指数(IOC1)与脑电双频指数(BIS)监测镇静水平的一致性,及伤害刺激敏感指数(IOC2)对镇痛水平监测的准确性。方法:顺序选取我院2018年11月—2021年1月行妇科腹腔镜手术的患者。监测BIS、IOC1及IOC2等指标,对IOC1、IOC2与BIS的相关关系进行分析;应用ROC曲线分析IOC2对伤害刺激发生时镇痛水平监测的准确性。结果:本研究共纳入87例患者。患者入室时、睫毛反射消失、插管时、开始气腹、气腹结束、停药、呼之睁眼及拔管时的IOC1与BIS的相关系数分别为0.503、0.580、0.362、0.544、0.485、0.596、0.601和0.385(P<0.01);IOC2与BIS的相关系数分别为,0.158(P>0.05),0.348(P<0.01),﹣0.088(P>0.05),0.528(P<0.01),0.400(P<0.01),0.408(P<0.01),0.473(P<0.01),0.118(P>0.05)。IOC2判断体动的准确性ROC曲线下面积(AUC)值为0.827(P<0.05)。IOC2测量值为63时取得最佳灵敏度64%和特异度97%。结论:IOC1与BIS具有较好的一致性;IOC2能够较准确地监测伤害刺激发生时患者的镇痛水平。

Objective:To evaluate the consistency of the index of consciousness(IOC)and the bispectral index(BIS)in monitoring the level of sedation and the accuracy of monitoring to noxious stimuli.Methods:Patients who underwent laparoscopy in the Department of Gynecology during Nov.2018-Jan.2021 in our hospital were selected randomly.Through the monitoring of BIS,IOC1 and IOC2,the correlation between IOC1,IOC2 and BIS was analyzed;receiver operating curve(ROC)analysis was used to verify the judgement accuracy of IOC2 on noxious stimuli.Results:A total of 87 patients were included in this study.The correlation coefficients of IOC1 and BIS were calculated when each patient entered the room,the eyelash reflex disappeared,before the laryngeal mask was inserted,the laryngeal mask was inserted,the pneumoperitoneum was started,the pneumoperitoneum ended,the drug was stopped,the eyes were opened,and extubation was managed.The correlation coefficients between IOC1 and BIS were 0.503,0.580,0.362,0.544,0.485,0.596,0.601 and 0.385,respectively(P<0.01);and the correlation coefficients between IOC2and BIS were 0.158(P>0.05),0.348(P<0.01),-0.088(P>0.05),0.528(P<0.01),0.400(P<0.01),0.408(P<0.01),0.473(P<0.01),and 0.118(P>0.05)respectively.ROC analysis was performed on the accuracy of IOC2 in judging body movement,and the area under the curve(AUC)value was 0.827(P<0.05).The best sensitivity and specificity were obtained when the IOC2 measurement value was 63,which were 64% and 97%,respectively.Conclusion:This study confirms that IOC1 and BIS have good consistency;IOC2 can accurately predict the level of noxious stimuli,which provides a theoretical basis for the choice of clinical anesthesia monitoring methods.