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
黎建金 1黎治滔1
作者信息
- 1. 北京大学深圳医院麻醉科,深圳 518036
- 折叠
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(BISpro0.909,NT0.965)、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.
Abstract
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)grade Ⅰ or Ⅱ,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 BlSpro 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 and NO 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(both P＞0.05).However,the efficiency of both BISpro and NT in predicting wakefulness and light sedation was poor(BISpro 0.666,NT 0.796),which was remarkably lower than that of Ces(0.927).The optimal cut-off value of BISpro for lost response was 76,with a sensitivity of 100％,and a specificity of 84.9％,and the area under the curve(AUC)was 0.98(P＜0.05).The optimal cut-off value of NT for lost re-sponse was 67,with a sensitivity of 97.1％,and a specificity of 93.7％,and the AUC was 0.97(P＜0.05).Conclusions During propo-fol sedation,BISpro and NT have poor consistency and fail to accurately predict light sedation,but can accurately monitor the sedation degree of patients under general anesthesia.
关键词
BISpro指数/Narcotrend指数/丙泊酚/镇静深度Key words
BISpro index/Narcotrend index/Propofol/Depth of sedation引用本文复制引用
出版年
2024
NETL
NSTL
万方数据