右美托咪定复合小剂量舒芬太尼用于镇静时BIS值与OAA/S评分的相关性研究

摘要

目的 探讨右美托咪定复合小剂量舒芬太尼用于镇静时脑电双频指数(BIS)监测镇静状态的准确性,并寻求该镇静方法下行有创操作最佳时机的BIS值.方法 随机选取行择期手术患者80例,ASA Ⅰ~Ⅱ级,在麻醉开始前依此静脉给予小剂量舒芬太尼0.1μg/kg以及右美托咪定,输注方法:负荷量1.0μg/kg,恒速输注15min;随后以0.3μg/kg恒速维持输注5min.记给药前时间点为T0,并记录各指标基础值;右美托咪定开始输注后5min、10min、15min以及20min,分别记为T1、T2、T3以及T4时间点,并以此四个时间点,将80例患者随机分为4组:T1组、T2组、T3组及T4组.分别记录各组患者对应时间点的HR、MAP、SpO2、BIS值以及OAA/S评分,分析BIS值与OAA/S评分的相关性,并通过受试者操作特性曲线(ROC)得出OAA/S=1时的最佳临界BIS值.结果 右美托咪定复合小剂量舒芬太尼用于镇静时对心率的影响较大.该方法下的BIS值与OAA/S评分呈正相关(r=0.95),且OAA/S=1时,最佳临界BIS值为44.5.结论 右美托咪定复合小剂量舒芬太尼用于镇静时BIS值与OAA/S评分具有较好的相关性,BIS值44.5可作为该镇静方法下行有创操作的较好参考指标.%Objective To assess the accuracy of bispectral index (BIS) in monitoring the sedation level with dexmedetomidine combined with small-dose of sufentanil.And, to analyze the BIS value of the best opportunity for invasive manipulation with this sedation method.MethodsEighty elective operation patients, ASA Ⅰ~Ⅱ, were randomLy selected for the study.Before the start of anesthesia, small-dose of sufentanil 0.1μg/kg and dexmedetomidine were injected in vein in sequence.The loading dose of dexmedetomidine was 1.0μg/kg for 15 min and the maintenance dose was 0.3μg/kg for 5 min.The time-pint before the start of injection was recorded as T0.And, T1, T2, T3, and T4 respectively presented the infusion time of dexmedetomidine for 5min, 10min, 15min and 20min.According to these four time-points, 80 patients were randomLy divided into four groups: group T1, group T2, group T3,and group T4.The relevant HR, MAP, SpO2, BIS value, and OAA/S score were separately recorded.Analyze the correlation of BIS and OAA/S score, and the cutoff value of BIS for OAA/S score=1 was obtained by analyzing receiver operating characteristic (ROC) curve.ResultsThe compound use of dexmedetomidine and sufentanil significantly decreased HR.With this sedation method, BIS value was positively correlated with OAA/S score (r=0.95), and the best cutoff value of BIS values for OAA/S score=1 was 44.5.ConclusionThere was a good correlation between BIS and OAA/S score in monitoring sedation with dexmedetomidine combined with small-dose of sufentanil.BIS=44.5 could be regarded as a good monitoring index of invasive manipulation with this sedation method.