脑电双频指数在评估心肺复苏成功患者的昏迷程度和判定预后中的价值  

Value of bispectral index in evaluating comatose degree and prognosis of the patients after cardiopulmonary resuscitation

作　　者：张明[1] 钱俊英[1] 李涛[1] 解建[1] 徐拥庆[1] 姜志明[1] 张众慧[1] 孙楠楠[1] 

机构地区：[1]山东省千佛山医院（山东大学附属千佛山医院）ICU,山东济南250014

出　　处：《中国急救医学》2012年第1期7-10,共4页Chinese Journal of Critical Care Medicine

基　　金：山东省科技发展计划项目（No.2009GG10002029）

摘　　要：目的探讨脑电双频指数（bispectral index，BIS）监测在评估心脏骤停后心肺复苏成功患者昏迷程度和判定预后中的价值。方法选取ICU病房心脏骤停后心肺复苏成功的昏迷患者，复苏后24h内行BIS监测，同时进行格拉斯哥昏迷评分（GCS），观察6个月预后。分析GCS评分与BIS的相关性及不同的GCS评分所对应的BIS值，比较不同GCS评分组间的BIS值和死亡率。分析BIS值与预后的关系，计算BIS值判定心肺复苏成功的昏迷患者6个月预后的敏感度、特异度、阳性预测值、阴性预测值、准确度。结果BIS值与GCS评分呈正相关（r=0．808，P〈0．01），随着GCS评分的升高，BIS值逐渐升高（P〈0．01），死亡率逐渐下降。死亡及植物状态率和意识恢复率与BIS值均具有相关性（x^2=22．42，P=0．000），预后越差，BIS值越低（P〈0．05）。BIS值≤40提示预后不良，敏感度100．00％，特异度65．00％；BIS值〉60提示预后良好，敏感度和特异度分别为83．33％和88．89％。BIS值为0的患者神经系统查体均符合脑死亡的诊断标准。结论BIS监测是评估心肺复苏成功患者昏迷程度和判定预后的有效指标，BIS值为0可成为诊断脑死亡的条件之一。Objective To evaluate the value of the bispectral index （BIS） monitoring in evaluating the comatose degree and prognosis of the patients after cardiopulmonary resuscitation （CPR）. Methods GCS and BIS of coma patients in ICU were recorded within 24 hours after successful CPR because of cardiac arrest. We observed the prognosis for six months, and analyzed the correlation between BIS and GCS, and the corresponding BIS of various GCS. BIS and mortality were compared among GCS groups. The correlation was analyzed between BIS and prognosis. Sensitivity, specificity, positive and negative predictive value, accuracy rate of BIS were computed for predicting the prognosis of coma patients after CPR for six months. Results BIS was positively related to GCS （ r = 0. 808, P 〈 0. 01 ）. With the advance of GCS, the BIS apparently increased（P 〈0. 01 ）and the mortality decreased. By linear Chi - square test, death or vegetative state rate and consciousness recovery rate were related to BIS （X2 = 22. 42, P = 0. 000）. The worse the prognosis was, the lower BIS was （ P 〈 0. 05 ）. BIS ≤ 40 suggested poor prognosis, the sensitivity and the specificity were 100. 00% and 65.00%. BIS 〉 60 suggested good prognosis, the sensitivity and the specificity were 83.33% and 88.89%. The examinations of nervous system in all patients whose BIS were zero met diagnostic criteria of brain death. Conclusion BIS monitoring is an effective index to evaluate the comatose degree and prognosis of patients after CPR. BIS （0 score） was one of diagnostic criteria of brain death.

关 键 词：脑电双频指数 心肺复苏 昏迷程度 预后 脑死亡 

分 类 号：R614.2[医药卫生—麻醉学]