Objective To explore the prediction of bispectral index (BIS) and the influence of age on the state of consciousness of patients with colon cancer during Midazolam target controlled infusion (TCI). Methods Clinical data of 40 patients receiving colon cancer surgery under epidural anesthesia in our hospital from February 2004 to February 2010 were analyzed retrospectively. These patients were divided into the young group (40-64 years old, group A) and the elder group (65-85 years old, group B) by age, with 20 patients in each group. TCI was implemented stage by stage based on the target concentration (Ce) of Midazolam effect-site and the state of consciousness was evaluated using the observer's assessment of alertness/sedation (OAA/S) scale. The BIS values and hemodynamic parameters immediately prior to each scoring were recorded. The probability of BIS in predicting sedative depth was analyzed and used to evaluate the predictability of BIS on the sate of consciousness. Results With the increase of Midazolam Ce, BIS of the two groups of patients decreased gradually with the same changing trend. When patients lost consciousness, the BIS was (61.6±7.9) for group A and (72.9± 5.9) for group B, and the Ce was (69.8±8.9)μg/L for group A and (53.3±9.4) μg/L for group B. At the same sedation score (OAA/S4-1), the BIS of group B was significantly higher than that of group A (P < 0.01). The prediction probability of BIS on lost consciousness was (0.883 ±0.034) for group A and (0.819 ±0.028) for group B, with no significant differences between the two groups (P > 0.05); during TCI, the heart rate and pulse oximetry saturation had no significant changes. Compared to the basic values, when OAA/S score dropped below 2, the blood pressure decreased (P < 0.05). Conclusion During midazolam TCI, BIS can predict the changes of state of consciousness equally for young patients and elder patients.%目的 探讨咪达唑仑靶控输注(TCI)期间脑电双频谱指数(BIS)对结肠癌患者意识状态变化的预测及不同年龄对其的影响.方法 回顾性分析我院2004年2月～2010年2月收治入院的采用硬膜外麻醉下行结肠癌手术患者40例临床资料,按照年龄不同进行分组,年轻组(40～64岁,A组)和老年组(65～85岁,B组),每组20例,按咪达唑仑效应室靶浓度(Ce)分阶段实施TCI,采用警觉/镇静(OAA/S)评分评价意识状态变化.记录每次评分前即刻的BIS值及血流动力学指标,分析BIS预测镇静深度的概率(Pk),通过Pk评价BIS对意识状态的预测效果.结果 随着咪达唑仑Ce增加,两组患者BIS逐渐降低,两组总体变化趋势一致.患者意识消失时,BIS值:A组为(61.6±7.9),B组为(72.9±5.9).Ce:A组为(69.8±8.9)μg/L,B组为(53.3±9.4)μg/L.同一镇静评分(OAA/S4-1)时,B组的BIS值明显高于A组(P＜0.01).两组BIS对于意识消失的预测概率(Pk):A组为(0.883±0.034),B组为(0.819±0.028),两组间比较差异无统计学意义(P＞ 0.05)；TCI期间两组心率和脉搏血氧饱和度无明显改变.与基础值比较,当OAA/S评分降至2分以下时,血压下降(P＜0.05).结论 咪达唑仑TCI期间、BIS能预测意识状态的变化,且对年轻患者和老年患者的预测相当.
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