Ramsay镇静评分与脑电双频指数在老年患者实施腰麻过程中静注咪达唑仑或丙泊酚的相关性研究

贵州医科大学    麻醉与心脏电生理课题组

翻译：王婷婷          编辑：王波          审校：曹莹


背景
背景jbhb

在脊髓麻醉中补充镇静剂或抗焦虑药已成为减轻患者焦虑和在手术过程中产生遗忘的标准方案。因此，明智地使用镇静剂可以使脊髓麻醉下的手术更舒适，并为老年患者，外科医生和麻醉师所接受。然而，过度镇静可能会危及患者的安全。适当的镇静有助于减少生理压力，从而获得更好的效果。因此，监测镇静的深度变得至关重要。Ramsay镇静评分（RSS）和脑电双频指数（BIS）是目前广泛应用的镇静深度评价指标。

方法


将60例在腰麻下行泌尿外科手术的老年患者随机分为咪达唑仑组（A组，n=30）和丙泊酚组（B组，n=30）。在A组中，患者初始推注咪达唑仑0.03 mg/kg，并在10分钟间隔内以0.01 mg/kg的剂量递增至最大2.5 mg。B组在2 min内静注异丙酚0.5 mg/kg，维持剂量为10-20 mg，以维持镇静深度。滴定镇静以达到BIS评分70-80和RSS评分34。在0（基线）、5、10、20、30、40、50和60分钟间隔测量心率、无创收缩压、舒张压、平均动脉压、血氧饱和度（SPO 2）以及BIS和RSS之间的相关系数。

结果


A 组不同时间点脑电双频指数（BIS）与镇静评分（RSS）的相关系数显示：5 分钟时为 – 0.76，20 分钟时为 – 0.64，30 分钟时为 – 0.78，40 分钟时为 – 0.56，50 分钟时为 – 0.39，均提示强相关性。B 组不同时间点 BIS 与 RSS 的相关系数显示：5 分钟时为 – 0.75，20 分钟时为 – 0.76，30 分钟时为 – 0.64，40 分钟时为 – 0.89，50 分钟时为 – 0.46，同样呈强相关性。研究还观察到，丙泊酚组（B 组）患者的 BIS 值降至更低水平，差异具有统计学意义，表明丙泊酚镇静起效更快。此外，B 组患者的心率（HR）和平均动脉压（MAP）显著低于 A 组。两组患者在平均年龄、性别构成及体重方面均无统计学差异。

【罂粟摘要】Ramsay镇静评分与脑电双频指数在老年患者实施腰麻过程中静注咪达唑仑或丙泊酚的相关性研究

结论


      BIS和RSS评分显示了70%-80%的强相关性，但B组（丙泊酚）的相关性大于A组（咪达唑仑）。因此，每种镇静药物的特性都会影响脊髓麻醉期间的镇静水平。临床医生应结合BIS值和其他客观镇静方法来确定镇静程度，而不是完全依赖BIS值。

原始文献来源：Sachdeva A, Jaswal S, Walia HS, Batra YK. Correlating the Depth of Sedation Between the Ramsay Sedation Scale and Bispectral Index Using Either Intravenous Midazolam or Intravenous Propofol in Elderly Patients Under Spinal Anaesthesia. Cureus. 2023;15(12):e50763. Published 2023 Dec 19. doi:10.7759/cureus.50763

Correlating the Depth of Sedation Between the Ramsay Sedation Scale and Bispectral Index Using Either Intravenous Midazolam or Intravenous Propofol in Elderly Patients Under Spinal Anaesthesia

Background: Supplementation of spinal anaesthesia with sedatives or anxiolytics has emerged as a standard protocol to alleviate patients’ anxiety and to produce amnesia during the surgical procedure. Thus, judicious use of sedation can make surgeries under spinal anaesthesia more comfortable and acceptable for the elderly patient, the surgeon, and the anaesthesiologist. However, over-sedation may jeopardise the safety of the patient. Appropriate sedation helps reduce physiological stress, which leads to a better result. Therefore, monitoring the depth of sedation becomes essential. The Ramsay sedation scale (RSS) and bispectral index (BIS) both are used widely to assess the depth of sedation.

Methods: A total of 60 elderly patients undergoing urological procedures under spinal anaesthesia were randomly assigned to receive either midazolam (Group A, n=30) or propofol (Group B, n=30) for sedation. In Group A, patients were given an initial bolus of midazolam 0.03 mg/kg and a maintenance incremental bolus of 0.01 mg/kg up to a maximum of 2.5 mg in 10-minute intervals. Group B used propofol with an initial bolus dose of 0.5 mg/kg over two minutes and a maintenance bolus of 10-20 mg as required for the maintenance of sedation depth. Sedation was titrated to achieve a BIS score of 70-80 and an RSS score of 3-4. Heart rate, non-invasive systolic, diastolic, mean arterial blood pressure, oxygen saturation (SPO2), and the correlation coefficient between the BIS and RSS were measured at 0 (baseline), 5, 10, 20, 30, 40, 50, and 60 minutes of interval.

Results：The correlation coefficient between the BIS and RSS scores in Group A at various time intervals indicate a strong correlation coefficient of -0.76 at five minutes, -0.64 at 20 minutes, -0.78 at 30 minutes, -0.56 at 40 minutes, and -0.39 at 50 minutes. In Group B, the correlation coefficient between the BIS and RSS scores at various time intervals indicate a strong correlation coefficient of -0.75 at five minutes, -0.76 at 20 minutes,-0.64 at 30 minutes, -0.89 at 40 minutes, and -0.46 at 50 minutes of interval. We also observed that the BIS drops to a lower level in patients receiving propofol (Group B) with a significant difference depicting early onset of sedation with propofol. In Group B, HR and MAP were significantly less than those of Group A. There was no significant difference in terms of mean age, sex, and body weight in the patients of both groups.

Conclusions: The BIS and RSS scores indicate a strong correlation with a magnitude of 70%-80%, but more in Group B (propofol) than Group A (midazolam). Therefore, the characteristics of each sedative drug can influence the level of sedation during spinal anaesthesia. Clinicians should use a combination of BIS values and other objective sedative methods to determine the degree of sedation, rather than relying exclusively on BIS values.

END