Chen Xuanling, Qin Xuewei, Zhuang Yutong, Li Zhengqian, Liang Zhenhu, Zhang Hua, Yao Lan, Li Xiaoli, He Jianghong, Guo Xiangyang
Department of Anesthesiology, Peking University International Hospital, Beijing, People's Republic of China.
Department of Neurosurgery, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.
Ther Clin Risk Manag. 2024 Sep 27;20:677-687. doi: 10.2147/TCRM.S478489. eCollection 2024.
To observe whether maintaining the appropriate depth of anesthesia with Bispectral Index (BIS) can improve the prognosis of Spinal Cord stimulation (SCS) implantation in patients with chronic Disorders of consciousness (DoC).
103 patients with DoC undergoing SCS implantation were reviewed, and 83 patients with DoC were included according to the standard of inclusion and exclusion Criteria. Patients were divided into a BIS group (n =45) and a non-BIS group (n =38) according to whether BIS monitoring was used during the operation. The depth of anesthesia in the BIS group was maintained between 40-60. The anesthesiologist adjusted the depth of anesthesia in the non-BIS group according to clinical experience. Relevant information such as disease course, cause, anesthesia time, and operation time were collected. Preoperative CRS-R score, postoperative CRS-R and postoperative CRS-R changes were collected.
The CRS-R(3m) score in the BIS group was higher than that in the non-BIS group , and the difference was statistically significant (P < 0.05). In CRS-R , the BIS group was higher than the non-BIS group, and the difference was statistically significant (X=8.787, P =0.004). The improvement of consciousness was included in the multivariate Logistic regression analysis model, and it was found that the thalamus was an independent factor affecting the improvement of consciousness (P < 0.05). During follow-up, 1 patient in the BIS group had a decrease in consciousness from MCS to VS/ UWS and 2 patients in the non-BIS group died during follow-up.
Patients can be benefit in hearing in CRS-R . We recommend the use of BIS to monitor the depth of anesthesia in patients with DoC to improve patient outcomes.
观察使用脑电双频指数（BIS）维持合适的麻醉深度是否能改善慢性意识障碍（DoC）患者脊髓刺激（SCS）植入术的预后。
回顾103例行SCS植入术的DoC患者，根据纳入和排除标准纳入83例DoC患者。根据手术中是否使用BIS监测，将患者分为BIS组（n = 45）和非BIS组（n = 38）。BIS组的麻醉深度维持在40 - 60之间。非BIS组的麻醉医生根据临床经验调整麻醉深度。收集病程、病因、麻醉时间和手术时间等相关信息。收集术前CRS - R评分、术后CRS - R及术后CRS - R变化情况。
BIS组CRS - R（3个月）评分高于非BIS组，差异有统计学意义（P < 0.05）。在CRS - R方面，BIS组高于非BIS组，差异有统计学意义（X = 8.787，P = 0.004）。将意识改善情况纳入多因素Logistic回归分析模型，发现丘脑是影响意识改善的独立因素（P < 0.05）。随访期间，BIS组有1例患者意识从MCS降至VS/UWS，非BIS组有2例患者在随访期间死亡。
患者在CRS - R听力方面可能获益。我们建议使用BIS监测DoC患者的麻醉深度以改善患者预后。
