BISpro指数和Narcotrend指数监测丙泊酚镇静深度的准确性对比研究  

Comparing of the accuracy of BISpro index and Narcotrend index for evaluating depth of sedation during propofol anesthe⁃sia

作　　者：黎建金 黎治滔 Li Jianjin;Li Zhitao(Department of Anesthesiology,Peiking University Shenzhen Hospital,Shenzhen 518036,China)

机构地区：[1]北京大学深圳医院麻醉科,深圳518036

出　　处：《国际麻醉学与复苏杂志》2024年第3期270-275,共6页International Journal of Anesthesiology and Resuscitation

摘　　要：目的比较BISpro指数(BISpro)和Narcotrend指数(NT)监测丙泊酚镇静深度的准确性、相关性和一致性。方法选择择期行宫腔镜手术的患者30例,美国麻醉医师协会(ASA)分级Ⅰ、Ⅱ级,年龄18~55岁。使用效应室模式靶控输注丙泊酚,初始浓度为1.0 mg/L,每2 min增加0.5 mg/L,直至患者入睡。每30 s记录1次BISpro、NT、心率、丙泊酚靶浓度(Ces)和镇静/警觉评估(OAA/S)评分。比较不同OAA/S评分之间的BISpro和NT;计算BISpro、NT、心率、Ces和OAA/S评分的相关系数,BISpro和NT的相关系数;使用Bland⁃Altman法对BISpro和NT进行一致性研究;比较BISpro、NT、心率、Ces对OAA/S评分预测概率(PK)是否存在差异性;绘制受试者操作特征(ROC)曲线,计算BISpro和NT判断患者意识消失时的最佳临界值。结果与OAA/S评分为3分、4分和5分比较,OAA/S评分≤2分时的BISpro和NT均降低,差异均有统计学意义(均P<0.05)。BISpro(r=0.761)、NT(r=0.831)和Ces(r=0.884)与OAA/S评分相关性良好(均P<0.001),BISpro与NT呈正相关(r=0.689,P<0.001)。BISpro和NT的一致性界限为−21.4~23.7,一致性界限内两者的最大差值为20。BISpro对OAA/S评分的PK值为0.884,稍低于NT(0.927),但明显比Ces高(0.768)。BISpro和NT均能准确预测清醒与深镇静(BISpro 0.909,NT 0.965)、清醒与意识消失(BISpro 1.000,NT 1.000),两者之间差异无统计学意义(均P>0.05);但两者预测清醒与浅镇静效能较差(BISpro 0.666,NT 0.796),明显低于Ces(0.927)。BISpro的最佳临界值为76,敏感度为100%,特异度为84.9%,曲线下面积(AUC)为0.98(P<0.05);NT判断患者意识消失的最佳临界值为67,敏感度为97.1%,特异度为93.7%,AUC为0.97(P<0.05)。结论丙泊酚镇静时,BISpro和NT一致性较差,不能准确预测患者的浅镇静状态,但可以准确监测全麻患者的镇静水平。Objective To compare the accuracy,correlation and consistency of BISpro index(BISpro)and Narcotrend index(NT)in evaluating the depth of propofol sedation.Methods A total of 30 female patients who undergoing elective hysteroscopic sur⁃gery,with American Society of Anesthesiologists(ASA)gradeⅠorⅡ,aged 18‒55 years were enrolled in this study.Propofol sedation was induced by an initial target-controlled concentration of 1.0 mg/L,followed by a stepwise increase 0.5 mg/L every 2 min until the pa⁃tient was in unresponsive state.Their BISpro,NT,heart rate,target-controlled effect-site concentration(Ces)of propofol,and the Ob⁃server's Assessment of Alertness and Sedation(OAA/S)score were recorded every 30 s.BISpro and NT were compared between pa⁃tients with different OAA/S scores.The correlation coefficients of BISpro,NT,heart rate and Ces with OAA/S scores were calculated,and the correlation coefficient between BISpro and NT was calculated.Bland-Altman analysis was performed to evaluate the consisten⁃cy between BISpro and NT.The differences in the prediction probability(PK)of BISpro,NT,heart rate and Ces for OAA/S score were compared.The optimal cut-off values of BISpro and NT for lost response were also calculated by the receiver operating characteristic(ROC)curve.Results Compared with those with OAA/S scores 3,4 and 5,decreased BISpro and NT were found in patients with OAA/S score≤2,with statistical differences(all P<0.05).BISpro(r=0.761),NT(r=0.831)and Ces(r=0.884)were well correlated with OAA/S scores (all P<0.001), and BISpro was positively related to NT (r=0.689, P<0.001). The consistency limit between BISpro andNO was from −21.4 to 23.7, and the maximum difference was 20. The PK of BISpro for OAA/S score was 0.884, which was slightly low⁃er than NT (0.927), but significantly higher than Ces (0.768). Both BISpro and NT accurately predicted wakefulness and deep sedation(BISpro 0.909, NT 0.965), as well as wakefulness and loss of response (BISpro 1.000, NT 1.000), without statistical differences

关 键 词：BISpro指数 NARCOTREND指数 丙泊酚 镇静深度 

分 类 号：R614[医药卫生—麻醉学]