程序化镇静镇痛中脑电疼痛指数与脑电双频谱指数的相关性分析

目的分析和评价程序化镇静镇痛中病人脑电疼痛指数（pain index，PI）与脑电双频谱指数（bispectral index，BIS）的相关性。方法选择择期在程序化镇静镇痛下施行整形外科手术的病人100例，美国麻醉医师协会（American Society of Anesthesiologists，ASA）分级Ⅰ级或Ⅱ级，年龄18~53岁。麻醉开始给予所有病人静脉单次输注咪达唑仑0.04 mg/kg，同时静脉持续输注右美托咪定（负荷剂量1 μg/kg，后以0.4~0.7 μg·kg-1·h-1静脉持续输注）和瑞芬太尼0.1 μg·kg-1·min-1。待BIS值维持在60~80后，手术部位注射膨胀液局部麻醉。使用BIS VISTA监护仪和HXD-I多功能组合式监护仪分别测量和记录病人在局麻开始（T₁）、手术开始（T₂）、麻醉后30 min（T₃）、麻醉后60 min（T₄）、停止输注右美托咪定即刻（T₅）、手术结束（T₆）各时间点的BIS值和PI值。分析各时间点PI值与BIS的相关性。结果在T₁~T₆各时点，PI值与BIS值均呈明显正相关关系（r=0.633~0.798，P < 0.05）。结论在程序化镇静镇痛中，PI值与BIS值呈明显正相关关系，PI值随着BIS值（镇静的减浅或加深）而上升或下降，表明PI值可作为评估程序化镇静镇痛有效性的良好监测指标。

Correlation analysis between encephlogram pain index and bispectral index during procedural sedation and analgesia

ObjectiveTo analyze and evaluate the correlation between encephlogram pain index(PI) and bispectral index(BIS) during procedural sedation and analgesia.MethodsA total of 100 patients scheduled by plastic surgery under procedural sedation and analgesia, aged 18-53(grade Ⅰ or Ⅱ the American Society of Anesthesiologists were selected.All patients were anesthetized with intravenous injection of single 0.04 mg/kg of midazolam at the beginning of anesthesia, and continuous intravenous infusion of dexmedetomidine(loading dose for 1 μg/kg, followed by 0.4 to 0.7 μg·kg-1·h-1) and remifentanil(0.1 μg·kg-1·min-1) at the same time.After the BIS value was sustained from 60 and 80, the dilating fluid was injected into the surgical site for local anesthesia.The PI and BIS value in all patients were measured and recorded at the beginning of local anesthesia and surgery(T₁ and T₂), after 30 min and 60 min of anesthesia induction(T₃ and T₄), immediately after turning off dexmedeto midine infusion(T₅) and at the end of surgery(T₆) using BIS VISTA monitor and HXD-I multi-function combined monitor, respectively.The correlation between PI and BIS at each time-point was analyzed.ResultsAt the time points of T₁-T₆, the PI value was significantly positively correlated with BIS value(r=0.633-0.798, P < 0.05).ConclusionsDuring procedural sedation and analgesia, the PI value is significantly correlated with BIS value.The PI value increases or decreases with the increasing and decreasing of BIS value(lightening or deepening of sedation), which suggests that the PI value can be used as a good monitor to assess the effectiveness of procedural sedation and analgesia.