BIS监测与RAS评分在肺性脑病有创机械通气患者镇静中相关性分析

Correlation analysis of bispectral index and richmond agitationsedation scale on sedated of patients of pulmonary encephalopathy with invasive mechanical ventilation

摘要:

目的分析脑电双频指数（BIS）与镇静程度评分表（RASS）在接受有创机械通气的肺性脑病患者中镇静深度评估的相关性。方法选择接受有创机械通气的肺性脑病患者38 例，予以丙泊酚或咪唑安定静脉泵入治疗确保患者达到合理镇静目标。每位患者均间隔30 min分别记录BIS 指数与RASS，比较RASS 对应各阶段BIS 指数中位数的总体差异。应用等级相关分析BIS 指数与RASS 的相关性。计算BIS 指数评估镇静不足与镇静过度的敏感性以及相应约登（Youden）指数，确定BIS 指数评估镇静程度的临床价值。结果RASS 对应各阶 段BIS 指数中位数间差异有统计学意义（P <0.05），且等级相关分析BIS 指数与RASS呈负相关（r =-0.824，P <0.05）；患者镇静程度从不足到过度，BIS 指数中位数降低（ P<0.05）。合理镇静时，RASS 为-3～0 级，对应的BIS 指数中位数（95%CI）分别为67（61，73）、70（66，76）、83（80，85）和89（87，94）。患者镇静不足时，BIS 指数中位数为81，其敏感性及约登指数最大，分别为0.87 和0.16；而镇静过度时，BIS 指数中位数为46，其敏感性及约登指数最大，分别为0.98 和0.78。结论BIS 指数与RASS 具有良好的相关性，能较好地监测接受有创机械通气的肺性脑病患者镇静程度。

Abstract:

Objective To analyze the effects of bispectral index (BIS) and Richmond Agitation-Sedation Scale (RASS) on sedated of patients of pulmonary encephalopathy with invasive mechanical ventilation. Methods A total of 38 patients of pulmonary encephalopathy with invasive mechanical ventilation were chosen and sedated by Propofol or Midazolam intravenously. Each patient was evaluated the sedation level by using BIS and RASS simultaneously every 30 minutes. The total difference of BIS median was compared with that of the corresponding RASS in each time point. The correlation of the BIS and the corresponding RASS was analyzed by the rank correlation analysis. The sensitivity and Youden indexes of BIS were calculated, and the clinical value of BIS to the sedation degree was identified. Results There was significant difference between BIS median and corresponding RASS in each time point (P < 0.05). There was negative correlation between BIS median and the corresponding RASS by the rank correlation analysis ( r= -0.824, P< 0.05). The BIS median decreased along with the increase of sedation depth (P <0.05). When the patients were optimally sedated, the RASS class was -3 ~ 0, and the corresponding BIS median (95%CI) was 67 (61, 73), 70 (66, 76), 83 (80, 85) and 89 (87, 94) respectively. When patients were insufficiently sedated, the BIS median was 81 and the sensitivity and Youden indexes of BIS were highest at this point, which was 0.87 and 0.16 respectively. When the sedation depth of patient was excessive, the BIS median was 46 and the sensitivity and Youden indexes of BIS were highest at this point, which were 0.98 and 0.78 respectively. Conclusion BIS index has a good correlation with RASS, which can monitor the sedation depth of patients of pulmonary encephalopathy with invasive mechanical ventilation.