脑电双频指数麻醉深度监测有效性评估的Meta分析  

A meta-analysis of the effectiveness evaluation of BIS anesthesia depth monitoring

作　　者：顾一纯 何达[1] 王江娜 郝佳君 梁鹏[4] 覃肖潇 张蕴伟 GU Yichun;HE Da;WANG Jiangna;HAO Jiajun;LIANG Peng;QIN Xiaoxiao;ZHANG Yunwei(Shanghai Health Development Research Center/Shanghai Medical Information Center,Shanghai 200031,China;School of Economics and Management,Jiangxi University of Chinese Medicine,Nanchang 330004,Jiangxi,China;School of Public Health,Zhejiang University School of Medicine,Hangzhou 310058,Zhejiang,China;Department of Anesthesiology,Day Surgery Center,West China Hospital,Sichuan University,Chengdu 610041,Sichuan,China)

机构地区：[1]上海市卫生和健康发展研究中心(上海市医学科学技术情报研究所),上海200031 [2]江西中医药大学经济管理学院,江西南昌330004 [3]浙江大学公共卫生学院,浙江杭州310058 [4]四川大学华西医院日间外科中心麻醉科,四川成都610041

出　　处：《健康发展与政策研究》2024年第6期492-499,共8页Health Development and Policy Research

摘　　要：目的系统评估脑电双频指数(bispectral index,BIS)用于麻醉深度监测的有效性。方法检索中国知网、万方、维普、中国生物医学文献服务系统(SinoMed)、Ovid-MEDLINE、Cochrane Library、PubMed、Web of Science、Embase等数据库,根据纳入和排除标准,收集所有相关随机对照试验,由2位评价员独立筛查文献、提取资料和评估方法学质量,使用R 4.0软件进行分析。结果共纳入92项研究。与传统麻醉深度监测相比,BIS监测能够显著减少患者术后谵妄(RR=0.56,95%CI:0.42~0.75,P<0.01),术中知晓(RR=0.51,95%CI:0.36~0.74,P<0.01)和术后认知功能障碍(RR=0.77,95%CI:0.67~0.89,P<0.01)的发生,显著缩短睁眼时间(MD=−2.55,95%CI:−3.75~−1.35,P<0.01),定向力恢复时间(MD=−5.38,95%CI:−8.94~−1.82,P<0.01),拔管时间(MD=−5.65,95%CI:−7.13~−4.17,P<0.01)和术后恢复室停留时间(MD=−9.47,95%CI:−13.50~−5.43,P<0.01),减少麻醉用药量(SMD=−1.02,95%CI:−1.37~−0.67,P<0.01)。麻醉中使用BIS监测与临床常规麻醉深度监测在术后恶心呕吐、异常血压发生率、死亡率、手术时间、预测意识恢复方面的差异无统计学意义。结论麻醉中使用BIS监测能够显著提高临床麻醉管理的效果,对保障患者的麻醉安全和手术安全均有积极意义。Objective To systematically evaluate the effectiveness of the Bispectral Index(BIS)in monitoring anesthesia depth.Methods CNKI,Wanfang,VIP,SinoMed,Ovid-MEDLINE,Cochrane Library,PubMed,Web of Science and Embase databases were searched,and all relevant randomized controlled trials were collected according to inclusion and exclusion criteria.Literature screening,data extraction,and methodological quality were assessed independently by two evaluators.R 4.0 software was used for analysis.Results A total of 92 studies were included.Compared to traditional depth monitoring of anesthesia,BIS monitoring significantly reduced the incidence of postoperative delirium(RR=0.56,95%CI:0.42~0.75,P<0.01),intraoperative awareness(RR=0.51,95%CI:0.36~0.74,P<0.01),and postoperative cognitive impairment(RR=0.77,95%CI:0.67~0.89,P<0.01).Additionally,it substantially shortened the time to eye opening(MD=−2.55,95%CI:−3.75~−1.35,P<0.01),recovery time to orientation(MD=−5.38,95%CI:−8.94~−1.82,P<0.01),extubation time(MD=−5.65,95%CI:−7.13~−4.17,P<0.01),and post-anesthesia care unit stay time(MD=−9.47,95%CI:−13.50~−5.43,P<0.01),while also reducing the amount of anesthesia drugs used(SMD=−1.02,95%CI:−1.37~−0.67,P<0.01).There were no significant differences between the use of BIS monitoring and traditional depth monitoring of anesthesia in postoperative nausea and vomiting,the incidence of abnormal blood pressure,mortality,operation time,and predicted recovery of consciousness.Conclusion The use of BIS monitoring in anesthesia can significantly improve the effectiveness of clinical anesthesia management,contributing positively to ensuring both the safety of patients undergoing anesthesia and he safety of surgeries.

关 键 词：脑电双频指数 麻醉深度监测 有效性 围手术期并发症 恢复时间 药物用量 意识转换 

分 类 号：R614[医药卫生—麻醉学]