【原】【罂粟摘要】术中使用甲苯磺酸瑞马唑仑镇静在脑电双频谱指数和患者状态指数中的比较

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术中使用甲苯磺酸瑞马唑仑镇静在脑电双频谱指数和患者状态指数中的比较

贵州医科大学   麻醉与心脏电生理课题组

翻译：宋雨婷   编辑：严旭   审校：曹莹

背景：脑电双频谱指数 （BIS） 和患者状态指数 （PSI） 是评估术中镇静深度的常用指标。然而，模型的差异导致不同的结果，这反过来干扰了临床医生对麻醉深度的判断。注射用甲苯磺酸瑞马唑仑（RT）是一种用于镇静的新型苯二氮䓬类药物，其在临床应用中镇静深度监测的有效指标很少。为了加深对这一领域的了解，本研究旨在比较BIS和PSI在术中使用瑞马唑仑后的敏感性和特异性，并探讨瑞马唑仑在椎管内麻醉老年患者中的安全性。

方法：本研究共纳入40例在椎管内麻醉下拟行择期前列腺电切术的患者，在手术期间同时接受BIS和PSI监测。当患者处于完全无痛状态时，在椎管内麻醉后静脉给予甲苯磺酸瑞马唑仑0.1mg / kg。然后观察并记录（每10分钟记录1分钟的数据）BIS，PSI，改良警觉/镇静（MOAA / S）评分和生命体征。Pearson的相关分析和线性回归模型分别用于比较BIS和PSI镇静评分，并分别分析BIS和PSI与MOAA/S评分的相关性。绘制ROC曲线以比较BIS和PSI的敏感性和特异性。生命体征的变化以均值±标准差表示。采用配对t检验分析围手术期肝肾功能指标，评价椎管内麻醉的老年患者术中使用瑞马唑仑的安全性。

结果：根据Pearson相关性分析，当术中使用瑞马唑仑后监测镇静的情况时，发现BIS和PSI之间存在显著（P < 0.01）相关性（r = 0.796）。还发现BIS与MOAA/S（r = 0.568，P < 0.01）以及PSI与MOAA/S（r = 0.390，P < 0.01 ）之间存在显著关联。BIS和PSI的ROC曲线下面积分别为0.801±0.022和0.734±0.026，表明这两种测量方法都可以预测患者的意识状态，并且BIS比PSI更准确。在整个研究过程中，生命体征保持稳定。根据肝肾功能检查结果来看，未发现具有临床意义的异常变化。

结论：BIS和PSI在术中监测瑞马唑仑的镇静情况密切相关。两种方法都能准确反映镇静深度。根据MOAA/S量表和ROC曲线的相关性分析，在这种术中监测中，BIS比PSI更准确。此外，瑞马唑仑可安全地用于椎管内麻醉老年患者的镇静，维持稳定的生命体征且对肾脏和肝脏影响较小。

原始文献来源：

Zhao, Tym., Chen, D., Xu, Zx. et al. Comparison of bispectral index and patient state index as measures of sedation depth during surgeries using remimazolam tosilate. BMC Anesthesiol 23, 208 (2023). 

英文原文：

Comparison of bispectral index and patient state index as measures of sedation depth during surgeries using remimazolam tosilate

Abstract

Background: The Bispectral Index (BIS) and the Patient State Index (PSI) are commonly used measures to assess intraoperative sedation depth. However, model differences lead to different results, which in turn interferes with clinicians’ judgment on the depth of anesthesia. Remimazolam tosilate (RT) for injection is a new benzodiazepine used in sedation. In its clinical application, there are few effective indicators for sedation depth monitoring. To close this gap, this study aims to compare BIS and PSI in measuring the sensitivity and specificity of intraoperative RT and to explore the safety of RT for intraspinal anesthesia in elderly patients.

Methods: This study included 40 patients undergoing elective electro-prostatectomy with intraspinal anesthesia, who were monitored by BIS and PSI simultaneously during operation. Remimazolam tosylate 0.1 mg/kg was intravenously administered after the intraspinal anesthesia when patients were in a completely painless status. Then BIS, PSI, the Modified Observer’s Assessment of Alertness and Sedation (MOAA/S) scores and vital signs were observed and recorded per minute for 10 min. Pearson’s correlation analysis and linear regression model were used to compare BIS and PSI sedation scores, and to test their associations with the MOAA/S score, respectively. ROC curves were drawn to compare the sensitivity and specificity of BIS and PSI. Changes of vital signs were presented as mean ± standard deviation. Perioperative liver and kidney function indicators were analyzed using a paired t-test to evaluate the safety of RT for intraspinal anesthesia in the elderly patients.

Results: According to Pearson’s correlation analysis, a significant (P < 0.01) correlation between BIS and PSI was found when used to monitor intraoperative sedation of RT (r = 0.796). Significant associations between BIS and MOAA/S (r = 0.568, P < 0.01), and between PSI and MOAA/S (r = 0.390, P < 0.01) were also found. The areas under the ROC curves of BIS and PSI were 0.801 ± 0.022 and 0.734 ± 0.026, respectively, suggesting that both measures may predict patients’ state of consciousness and BIS was more accurate than PSI. Vital signs remained stable throughout the study. No abnormal changes of clinical significance were found based on laboratory test results of liver and kidney function.

Conclusion: BIS and PSI are strongly associated for monitoring the sedation of RT intraoperatively. Both methods can accurately reflect sedation depth. According to correlation analyses with MOAA/S scale and ROC curves, BIS is more accurate than PSI during such intraoperative monitoring. In addition, RT can be safely used in elderly patients under intraspinal anesthesia for supportive sedation, with stable vital signs and sound kidney and liver safety profiles.