Cottenceau V, Masson F, Soulard A, Petit L, Guehl D, Cochard J-F, Pinaquy C, Leger A, Sztark F
Service de réanimation chirurgicale et traumatologique, SAR 1, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, Bordeaux, France.
Ann Fr Anesth Reanim. 2012 Dec;31(12):e275-81. doi: 10.1016/j.annfar.2012.09.007. Epub 2012 Nov 20.
Bispectral index (BIS) may be used in traumatic brain-injured patients (TBI) with intractable intracranial hypertension to adjust barbiturate infusion but it is obtained through a unilateral frontal electrode. The objective of this study was to evaluate differences in BIS between hemispheres in two groups: unilateral frontal (UFI) and diffuse (DI) injured.
Prospective monocenter observational study in 24 TBI treated with barbiturates: 13 UFI and 11 DI. Simultaneous BIS and EEG was recorded for 1h. Goal of monitoring was a left BIS between 5 and 15. Biases in BIS were considered as clinically relevant if greater than 5. Differences in biases were interpreted from both statistical (Mann-Whitney test) and clinical points of view.
Mean BIS in the two hemispheres remained in the same monitoring range. There were statistic and clinical differences in some values in the two groups of patients (15% of bias greater than I5I in UFI group and 10% in DI group). BIS monitoring allowed the adequate number of bursts/minutes to be predicted in 18 patients and did not detect an overdosage in 2.
While asymmetric BIS values in TBI patients occur whatever the kind of injury, they were not found to be clinically relevant in most of these heavily sedated patients. Asymmetrical BIS monitoring might be sufficient to monitor barbiturate infusion in TBI provided that the concordance between BIS and EEG is regularly checked.
脑电双频指数（BIS）可用于伴有顽固性颅内高压的创伤性脑损伤（TBI）患者，以调整巴比妥类药物输注，但它是通过单侧额电极获得的。本研究的目的是评估两组患者半球间BIS的差异：单侧额叶损伤（UFI）组和弥漫性损伤（DI）组。
对24例接受巴比妥类药物治疗的TBI患者进行前瞻性单中心观察性研究：13例UFI患者和11例DI患者。同时记录BIS和脑电图1小时。监测目标是左侧BIS在5至15之间。如果BIS偏差大于5，则认为具有临床相关性。从统计学（曼-惠特尼检验）和临床角度解释偏差差异。
两个半球的平均BIS保持在相同的监测范围内。两组患者在某些值上存在统计学和临床差异（UFI组15%的偏差大于|5| , DI组为10%）。BIS监测能够预测18例患者每分钟足够数量的爆发，且未检测到2例患者用药过量。
无论何种损伤类型，TBI患者都会出现BIS值不对称的情况，但在大多数这些深度镇静患者中，未发现其具有临床相关性。只要定期检查BIS与脑电图之间的一致性，不对称BIS监测可能足以监测TBI患者的巴比妥类药物输注情况。
