Cho Jae Heung, Cheong Soon Ho, Kim Hyun Sik, Kim Se Hoon, Cho Kwang Rae, Lee Sang Eun, Kim Young Hwan, Lim Se Hun, Lee Jeong Han, Lee Keun Moo, Choi Young Kyun, Kim Young Jae, Shin Chee Man
Department of Anesthesiology and Pain Medicine, Paik Hospital, Inje University, College of Medicine, Busan, Korea.
Korean J Anesthesiol. 2009 Aug;57(2):185-189. doi: 10.4097/kjae.2009.57.2.185.
It is important to assess the level of consciousness in patients with brain injuries to determine modes of treatment and prognosis. We evaluated the Bispectral Index (BIS) to determine if it could be used as an objective tool for evaluation of the level of consciousness in brain-injured patients. We also compared the BIS values to clinical sedation scales such as the Glasgow Coma Scale (GCS), Richmond Agitation-Sedation Scale (RASS), and the Reaction Level Scale (RLS).
Thirty eight patients with brain injuries that were admitted to the neurosurgery intensive care unit (NSICU) were enrolled in this study. An investigator evaluated the clinical sedation scales (GCS, RASS, RLS), while a blind observer noted the BIS in the same patient. The BIS score was obtained three times at an interval of 5 hours. The BISs were measured for 1 minute at 5 min prior to the nursing assessment, during the nursing assessment, and at 5 min after the nursing assessment. The BISs used in the data analysis were the maximal, minimal, and mean values obtained during 1 min, which were defined as BISmax, BISmin, and BISmean. A Spearman's rank correlation coefficient was used to determine if the clinical sedation scales were correlated with the BIS scores.
In 38 patients, the BISmax, BISmin, and BISmean were found to be significantly correlated with the GCS, RASS, and RLS. The BISmean had the highest correlation with GCS (r = 0.445, P < 0.01), while the BIS min had the lowest correlation with RLS (r = -0.278, P < 0.01).
The results of BIS monitoring were found to be significantly correlated with sedation scales in patients with brain injuries. These findings suggest that BIS can be used as an objective and continuous method for assessment of the level of consciousness in patients with brain injury.
评估脑损伤患者的意识水平对于确定治疗方式和预后很重要。我们评估了脑电双频指数（BIS），以确定其是否可作为评估脑损伤患者意识水平的客观工具。我们还将BIS值与临床镇静量表进行了比较，如格拉斯哥昏迷量表（GCS）、里士满躁动 - 镇静量表（RASS）和反应水平量表（RLS）。
本研究纳入了38例入住神经外科重症监护病房（NSICU）的脑损伤患者。一名研究者评估临床镇静量表（GCS、RASS、RLS），同时一名盲法观察者记录同一患者的BIS。BIS评分每隔5小时获取3次。在护理评估前5分钟、护理评估期间以及护理评估后5分钟测量BIS 1分钟。数据分析中使用的BIS值为1分钟内获得的最大值、最小值和平均值，分别定义为BISmax、BISmin和BISmean。采用Spearman等级相关系数来确定临床镇静量表与BIS评分是否相关。
在38例患者中，发现BISmax、BISmin和BISmean与GCS、RASS和RLS显著相关。BISmean与GCS的相关性最高（r = 0.445，P < 0.01），而BISmin与RLS的相关性最低（r = -0.278，P < 0.01）。
发现BIS监测结果与脑损伤患者的镇静量表显著相关。这些发现表明，BIS可作为评估脑损伤患者意识水平的一种客观且连续的方法。
