脑电双频指数监测临床应用的新进展

背景 麻醉深度判断一直是临床医师非常关注的问题.脑电双频指数（bispectral index,BIS）监测是目前应用最为广泛的量化麻醉深度的监测手段,随着BIS监测的普及,其应用价值也不断得到更深入的认识. 目的 就BIS临床应用的新进展作一综述. 内容 术中BIS监测可以使麻醉医师以适合的麻醉深度为目标个体化按需给药,既有助于避免麻醉过浅导致术中知晓,也可避免不必要的麻醉过深而造成的术后恢复延迟,这对于慢性肝病患者的麻醉尤其重要.术中BIS监测有助于通过避免麻醉过深加快患者术后认知功能恢复,并可能改善患者远期预后.对于围术期全脑缺血的高危患者,术中BIS突然下降可能提示脑灌注不足.BIS监测可能还有助于对心跳骤停、心肺复苏后患者的预后判断,但用于预后判断的最佳监测时间和界值仍有待进一步研究阐明. 趋向 术中BIS监测能够预防术中知晓和避免麻醉过深,降低术后谵妄的发生率,并在肝病患者神志判断和麻醉、高危手术围术期脑缺血监测及心肺复苏患者的预后判断等领域有很好的应用价值.

The update in clinical application of bispectral index monitoring

Background Assessment of hypnotic depth has been deeply concerned by anesthetists all the time.Bispectral index （BIS） monitoring is now the most widely used approach to quantitively measure the hypnotic component of anesthesia.With its extensive using,the value of BIS monitoring receives better understanding.Objective To review recent advances in clinical application of BIS monitoring.Content Using BIS monitoring to guide anaesthetic administration allows optimization of drug delivery according to the needs of individual patients.This helps to avoid both too light anesthesia which may lead to intraoperative awareness and too deep anaesthesia which may give rise to delayed emergence.These are particularly important for patients with chronic liver disease.Besides,recent studies indicate that BIS-guided anesthesia helps to accelerate cognitive function recovery.BIS monitoring is also found to be useful for patients at high risk of global cerebral ischemia.For these patients,a sudden reduction of BIS value may suggest the occurrence of cerebral hypoperfusion.Furthermore,BIS monitoring may be helpful in estimating prognosis of patients after cardiac arrest and cardiopulmonary resuscitation.However,the optimal duration of BIS monitoring and the optimal cutoff point of BIS value for prognostic estimation in these patients are still unclear.Trend Using BIS monitoring helps to avoid intraoperative awareness and too deep anaesthesia,which is correlated with faster recovery of cognitive function.BIS is also found to be very useful in patients with chronic liver disease,recognition of occurance of cerebral hypoperfusion and prognosis of patients after cardiac arrest and cardiopulmonary resuscitation.