脑状态指数对子宫全切术患者地氟醚全麻苏醒期意识水平的监测价值  

Value of brain status index in monitoring level of consciousness during recovery period of desflurane anesthesia in patients undergoing total hysterectomy

作　　者：董芳 王亚男 DONG Fang;WANG Yanan(Department of Obstetrics and Gynecology,Daxing District People's Hospital of Beijing,Beijing 102600,China)

机构地区：[1]北京市大兴区人民医院妇产科,北京102600

出　　处：《新疆医科大学学报》2023年第9期1199-1205,共7页Journal of Xinjiang Medical University

基　　金：北京市卫生健康委卫生发展科研项目(2022-CZ-4056)。

摘　　要：目的探讨脑状态指数(Cerebral state index,CSI)对子宫全切术患者地氟醚全麻苏醒期意识水平的监测价值。方法选取北京市大兴区人民医院妇产科需行子宫全切术的患者136例,地氟醚全麻期间监测CSI[舒适指数(Comfort index,CFi)、谵妄指数(Delirium index,DELi)、镇静指数(Wavelet index,WLi)、皮层兴奋指数(Cortical excitation index,CEi)、皮层下兴奋指数(Subcortical excitation index,SCEi)],麻醉停止后记录苏醒时间,根据意识恢复时间分为苏醒延迟组(意识恢复时间≥30 min)、正常组(意识恢复时间<30 min)。多因素Logistic回归模型分析CSI对意识恢复的影响,限制性立方样条图分析CSI与意识恢复的剂量-反应关系,受试者工作特征曲线(ROC)分析CSI对子宫全切术患者地氟醚全麻苏醒期意识水平的评估效能。结果136例患者苏醒延迟发生率为15.44%(21/136);第一次反应前CFi(OR=2.725,95%CI:1.891~3.928)、DELi(OR=2.617,95%CI:1.627~4.211)是苏醒延迟的独立危险因素,第一次反应前WLi(OR=0.334,95%CI:0.182~0.614)、CEi(OR=0.278,95%CI:0.121~0.637)、SCEi(OR=0.377,95%CI:0.203~0.702)是苏醒延迟的独立保护因素(P<0.05);当CFi>21、DELi>12.5时,随CFi、DELi增加,苏醒延迟风险增加;当WLi<50、CEi<36、SCEi<16.5时,随CEi、SCEi减小,苏醒延迟风险增加;预测模型检测的曲线下面积(Area under curve,AUC)为0.912,高于CFi、DELi、WLi、CEi、SCEi单独评估(Z/P=3.706/<0.001,3.466/0.001,3.485/0.001,3.866/<0.001,4.199/<0.001)。结论CSI与子宫全切术患者地氟醚全麻苏醒期意识水平关系密切,可通过检测CSI对子宫全切术患者地氟醚全麻苏醒期意识水平进行评估。Objective To investigate the value of brain state index(CSI)in monitoring the level of consciousness during the recovery period of desflurane anesthesia in patients undergoing total hysterectomy.Methods A total of 136 patients requiring total hysterectomy in the hospitalwere selected.During general anesthesia with desflurane,CSI[comfort index(CFi),delirium index(DELi),sedation index(WLi),cortical arousal index(CEi),subcortical arousal index(SCEi)]was monitored,and the recovery time after anesthesia was stopped and recorded.The recovery stage was divided into the delayed recovery group and normal group.The effects of CSI on consciousness recovery were analyzed by Logistic regression model.The dose-response relationship between CSI and consciousness recovery was analyzed by restricted cubic spline diagram.Receiver operating characteristic curve(ROC)was used to analyze the effectiveness of CSI in evaluating consciousness level during awakening period of general anesthesia.Results The incidence of delayed awakening in 136 patients was 15.44%(21/136).CFi(OR=2.725,95%CI:1.891~3.928)and DELi(OR=2.617,95%CI:1.627~4.211)before the first reaction were independent risk factors for delayed recovery,while WLi(OR=0.334,95%CI:0.182~0.614),CEi(OR=0.278,95%CI:0.121~0.637)and SCEi(OR=0.377,95%CI:0.203~0.702)before the first reaction were independent protective factors for delayed recovery(P<0.05).When CFi>21 and DELi>12.5,the risk of recovery delay wasincreased with the increase of CFi and DELi.When WLi<50,CEi<36,SCEi<16.5,the risk of recovery delaywasincreased with the decrease of CEi and SCEi.The AUC value of prediction model detection was 0.912,and it was higher than that of CFi,DELi,WLi,CEi and SCEi separately(Z/P=3.706/<0.001,3.466/0.001,3.485/0.001,3.866/<0.001,4.199/<0.001).Conclusion CSI is closely related to the consciousness level of the patients undergoing total hysterectomy under general anesthesia desflurane,and it can be evaluated by detecting CSI.

关 键 词：脑状态指数 子宫全切术 地氟醚 意识水平 

分 类 号：R714[医药卫生—妇产科学]