靶控输注咪唑安定时脑状态指数和脑电双频谱指数镇静深度监测准确性比较

目的比较脑状态指数(CSI)与脑电双频谱指数(BIS)在咪唑安定镇静深度监测方面的准确性。方法以20例男性志愿者为研究对象,采用血浆靶控输注方式,从30ng/ml开始,达到效应室平衡后,继续增加靶浓度(每次增加10ng/ml),直到挤压斜方肌有反应,即镇静评分(OAA/S)1级。每次达到平衡后评价OAA/S,整个镇静过程中同时监测BIS和CSI。计算BIS、CSI预测不同OAA/S分级的预测概率(Pk),采用概率分析计算受试者出现语言反应消失(LVC)及意识消失(LOR)时的BIS05、BIS50、BIS95和CSI05、CSI50、CSI95。结果在整个镇静过程中,BIS和CSI均与OAA/S有较好的相关性,随镇静程度加深,BIS与CSI都呈进行性下降。用于预测LVC时,BIS和CSI的Pk值分别为84%和74%;用于预测LOR时,BIS和CSI的Pk值分别为79%和68%。出现LVC时,BIS05、BIS50和BIS95分别为85.5、60.6和35.7,CSI05、CSI50和CSI95分别为82.2、65.2和30.3;出现LOR时,BIS05、BIS50和BIS95分别为79.7、47.6和15.6,CSI05、CSI50和CSI95分别为75.9、43.4和11.0。结论在靶控输注咪唑安定镇静时,BIS与CSI都与镇静深度有较好的相关性,且都能预测LVC和LOR,但BIS的预测能力优于CSI。

Comparison of cerebral state index and bispectral index accuracies in sedation monitoring during target control infusion of midazolam

Objective To compare the accuracies of cerebral state index(CSI)and bispectral index(BIS)in sedation monitoring during target control infusion of midazolam.Methods Twenty informed adult male volunteers were intravenously administered with midazolam through plasma target control infusion from 30ng/ml(in increments of 10ng/ml every time)until they became unresponsive to tactile stimulation(i.e.,mild prodding or shaking).The BIS and CSI were continuously recorded simultaneously.Sedation was assessed using the Observers' Assessment of Alertness/Sedation(OAA/S)scale at each time when Ct equaled to Ce.The electroencephalogram(EEG)parameters were correlated with the OAA/S scores using nonparametric Spearman's correlation analysis.The prediction probabilities were calculated at the points of lost of verbal contact(LVC)and lost of responses to stimulus(LOR).BIS05,BIS50,BIS95,and CSI05,CSI50,CSI95 were also calculated for LVC and LOR.Results BIS and CSI were well correlation with OAA/S scales during both the onset and recovery phases.When the sedation level increased,BIS and CSI progressively decreased.The prediction probabilities of BIS and CSI were 84%,74% for LVC and 79%,68% for LOR,while the BIS05,BIS50,and BIS95 as well as CSI05,CSI50,and CSI95 were 85.5,60.6,and 35.7(for BISs)and 82.2,65.2,and 30.3(for CSIs)at the point of LVC and 79.7,47.6,and 15.6(for BISs)and 75.9,43.4,and 11(for CSIs)at the point of LOR.Conclusions Both CSI and BIS seem to be useful parameters for assessing midazolam-induced sedation.BIS is superior in the prediction of LVC and LOR.