Miner James R, Gaetz Andrea, Biros Michelle H
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA.
Am J Emerg Med. 2007 Sep;25(7):743-8. doi: 10.1016/j.ajem.2006.12.002.
This study was conducted to compare the level of awareness as determined by serial bispectral index (BIS) electroencephalogram scores to a standardized Altered Mental Status (AMS) scale used to define a patient's clinical level of agitation or sedation, and the patient's concurrent breath/blood alcohol concentration (BAC).
This was an institutional review board-approved, prospective observational study of a convenience sample of patients who presented to the emergency department (ED) with the chief complaint of ethanol (ETOH) intoxication between July 19, 2003, and March 27, 2004. The AMS scale is a 9-point scale: -4 is unresponsive, 0 is normal examination, and +4 is extremely agitated. After ETOH was detected by breath analyzer, enrolled patients had a BIS monitor probe applied to their forehead. Baseline BAC, BIS, and AMS scores were recorded independently of the patients' caregivers. Bispectral index and AMS scores were repeated every 20 minutes for 1 hour. The patient's diagnosis, disposition, (any) complications, and total time in department were recorded.
Ninety-eight patients were enrolled in the study. The median presenting AMS score was -1. The mean total time in department was 402.6 minutes (SD, 196.4; range, 246-906 minutes). The mean presenting BIS score was 77.6 (SD, 17.9; range, 26-98). The mean presenting BAC was 0.229 (SD, 0.07; range, 0.049-0.43). The mean BIS index varied from 59.6 +/- 16.9 for AMS scores of -4, to 96.3 +/- 2.7 for AMS scores of 0, to 90.5 +/- 4.9 for AMS scores of 4. The AMS scale correlated with the BIS scale (Spearman's rho = 0.67, P < or = .001), but did not correlate with BAC (Spearman's rho = -0.14, P = 0.15).
Changes in the AMS scale corresponded to changes in the BIS index score. A decreased level of awareness, as determined on the BIS index, was observed in patients who were either agitated or sedated by the AMS. We conclude that both agitated and sedated patients with ETOH intoxication show decreases in their level of awareness. Therefore, the AMS scale, which includes both agitation and sedation, is a valid measure of a patient's decreased level of awareness.
本研究旨在比较通过连续脑电双频指数（BIS）脑电图评分所确定的意识水平，与用于定义患者躁动或镇静临床水平的标准化精神状态改变（AMS）量表，以及患者同时的呼吸/血液酒精浓度（BAC）。
这是一项经机构审查委员会批准的前瞻性观察性研究，研究对象为2003年7月19日至2004年3月27日因乙醇（ETOH）中毒为主诉到急诊科（ED）就诊的便利样本患者。AMS量表为9分制：-4表示无反应，0表示检查正常，+4表示极度躁动。通过呼气分析仪检测到ETOH后，纳入研究的患者在前额应用BIS监测探头。独立于患者护理人员记录基线BAC、BIS和AMS评分。每20分钟重复记录双频指数和AMS评分，持续1小时。记录患者的诊断、处置情况、（任何）并发症以及在科室的总时间。
98名患者纳入研究。就诊时AMS评分的中位数为-1。在科室的平均总时间为402.6分钟（标准差，196.4；范围，246 - 906分钟）。就诊时BIS评分的平均值为77.6（标准差，17.9；范围，26 - 98）。就诊时BAC的平均值为0.229（标准差，0.07；范围，0.049 - 0.43）。双频指数平均值从AMS评分为-4时的59.6±16.9，到AMS评分为0时的96.3±2.7，再到AMS评分为4时的90.5±4.9。AMS量表与BIS量表相关（Spearman秩相关系数 = 0.67，P≤0.001），但与BAC不相关（Spearman秩相关系数 = -0.14，P = 0.15）。
AMS量表的变化与BIS指数评分的变化相对应。通过BIS指数确定，在因AMS量表表现为躁动或镇静的患者中观察到意识水平下降。我们得出结论，ETOH中毒的躁动和镇静患者均表现出意识水平下降。因此，涵盖躁动和镇静情况的AMS量表是衡量患者意识水平下降的有效指标。
