意识指数监测腹腔镜手术中七氟醚麻醉深度的效果

Effect of index of consciousness for monitoring the depth of anesthesia maintained by sevoflurane during laparoscopic surgery

目的比较意识指数(IoC1)和脑电双频指数(BIS)在腹腔镜胆囊切除术或子宫附件切除术中监测七氟醚麻醉深度的一致性和准确性。方法选择择期行腹腔镜胆囊或子宫附件切除术患者100例,男9例,女91例,年龄18~75岁,BMI 18.5~24.9 kg/m^(2),ASAⅠ或Ⅱ级。常规麻醉诱导插管,吸入七氟醚麻醉维持,同时监测IoC1和BIS。记录清醒状态时、麻醉诱导开始时、意识消失时、气管插管前、气管插管时、七氟醚吸入开始、手术开始时、气腹充气完毕即刻、腹腔冲洗开始1 min后、气腹结束时、手术结束时、气道吸引时、意识恢复即刻、气管拔管前、气管拔管后、出PACU时的IoC1和BIS。采用Bland-Altman分析两种麻醉深度指数的95%一致性界线(LOA)。采用受试者工作特征(ROC)曲线分析两种麻醉深度指数预测意识状态的效能。结果从清醒至丙泊酚麻醉诱导完成,BIS和IoC1的平均差值为1.3(95%LOA-21.2~23.8)。从七氟醚吸入开始至出PACU,BIS和IoC1的平均差值为3.3(95%LOA-15.1~21.7)。麻醉诱导过程中,IoC1和BIS监测意识消失的AUC分别为0.987(95%CI 0.982~0.993)和0.980(95%CI 0.968~0.992),最佳界值分别为76.5(敏感性为98.0%,特异性为94.8%)和81.5(敏感性为95.0%,特异性为96.8%)。麻醉苏醒过程中,IoC1和BIS监测意识恢复的AUC分别为0.979(95%CI 0.977~0.989)和0.983(95%CI 0.972~0.987),最佳界值分别为72.5(敏感性为97.1%,特异性为93.3%)和76.5(敏感性为96.1%,特异性为94.9%)。结论麻醉深度监测指数IoC1和BIS的一致性较好,在腹腔镜胆囊或子宫附件切除术中均能准确反映七氟醚麻醉维持时的麻醉深度。

Objective To compare the agreement and accuracy of index of consciousness(IoC1)and bispectral index(BIS)in monitoring depth of anesthesia under sevoflurane anesthesia during laparoscopic cholecystectomy or adnexal hysterectomy.Methods A total of 100 patients were enrolled in elective laparoscopic cholecystectomy or adnexal hysterectomy under general anesthesia,9 males and 91 females,aged 18-75 years,BMI 18.5-24.9 kg/m^(2),ASA physical statusⅠorⅡ.Routine anesthesia induction and intubation were performed in each patient,maintaining anesthesia by sevoflurane.The values of IoC1 and BIS were recorded at different time points including when patients awakening,at the beginning of anesthesia induction,at the time of loss of consciousness,before and during endotracheal intubation,at the beginning of sevoflurane inhalation,at the beginning of operation,immediately after completion of pneumoperitoneum inflation,after 1 min following abdominal irrigation,at the end of pneumoperitoneum,at the end of operation,during airway suction,at the time of recovery of consciousness,before and after tracheal extubation,and at the time of leaving the postanesthesia care unit(PACU).Bland-Altman analysis was used to analyze the 95%limits of agreement(LOA)of two kinds of anesthesic depth indexes.The receiver operator characteristic(ROC)curve was used to analyze the predictive efficiency of the two anesthetic depth indexes on the state of consciousness.Results From awaking to completion of anesthesia introduced by propofol,the mean difference between IoC1 and BIS was 1.3 and the 95%LOA of both indexes ranged from-21.2 to 23.8.From the beginning of sevoflurane inhalation to exiting from the PACU,the mean difference between IoC1 and BIS was 3.3 and the 95%LOA of both indexes ranged from-15.1 to 21.7.During anesthesia induced by propofol,the AUC of the loss of consciousness in IoC1 and BIS monitoring was 0.987(95%CI 0.982-0.993)and 0.980(95%CI 0.968-0.992),respectively.The optimal cutoff values of IoC1 and BIS indexes for monitoring the loss of consciousness were 76.5(sensitivity was 98.0%,specificity was 94.8%)and 81.5(sensitivity was 95.0%,specificity was 96.8%),respectively.During anesthesia recovery,the AUC of recovery of consciousness in regard to IoC1 and BIS monitoring was 0.979(95%CI 0.977-0.989)and 0.983(95%CI 0.972-0.987),respectively.The optimal cutoff values of IoC1 and BIS in monitoring the recovery of consciousness were 72.5(sensitivity was 97.1%,specificity was 93.3%)and 76.5(sensitivity was 96.1%,specificity was 94.9%),respectively.Conclusion The depth of anesthesia monitoring index IoC1 is in good agreement with BIS,and can accurately reflect the anesthetic depth during sevoflurane anesthesia maintenance in laparoscopic cholecystectomy or adnexal hysterectomy.