观察者警觉/镇静评定评分与脑电双频谱指数监测在全麻诱导期丙泊酚滴定给药中的相关性

doi:10.12122/j.issn.1673-4254.2025.01.07

南方医科大学学报 ›› 2025, Vol. 45 ›› Issue (1): 52-58.doi: 10.12122/j.issn.1673-4254.2025.01.07

观察者警觉/镇静评定评分与脑电双频谱指数监测在全麻诱导期丙泊酚滴定给药中的相关性

陈丽红¹^,³(), 谢惠琳¹, 黄霞¹, 罗彤枫¹, 郭婧¹, 林春萌¹, 刘雪艳¹, 史李铄², 靳三庆¹^,³()

^1.中山大学附属第六医院，麻醉科，广东广州 510655
^2.中山大学附属第六医院，临床研究中心，广东广州 510655
^3.中山大学附属第六医院，广州市黄埔区中六生物医学创新研究院，广东广州 510655

收稿日期:2024-09-26 出版日期:2025-01-20 发布日期:2025-01-20
通讯作者: 靳三庆 E-mail:chenlihn@mail.sysu.edu.cn;jinsq@mail.sysu.edu.cn
作者简介:陈丽红，博士，主治医师，E-mail: chenlihn@mail.sysu.edu.cn
基金资助:
广东省医学科学技术研究基金项目(A2022002)

Correlation between the Observer's Assessment of Alertness/Sedation score and bispectral index in patients receiving propofol titration during general anesthesia induction

Lihong CHEN¹^,³(), Huilin XIE¹, Xia HUANG¹, Tongfeng LUO¹, Jing GUO¹, Chunmeng LIN¹, Xueyan LIU¹, Lishuo SHI², Sanqing JIN¹^,³()

^1.Department of Anesthesiology, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China
^2.Center for Clinical Research, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China
^3.Biomedical Innovation Center, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China

Received:2024-09-26 Online:2025-01-20 Published:2025-01-20
Contact: Sanqing JIN E-mail:chenlihn@mail.sysu.edu.cn;jinsq@mail.sysu.edu.cn

摘要/Abstract

摘要：

目的探讨全麻诱导期丙泊酚滴定给药过程中，观察者警觉/镇静评定（OAAS）评分与脑电双频谱指数（BIS）之间的关系，分析BIS监测延迟对麻醉深度评估的影响。方法纳入90例美国麻醉医师协会（ASA）分级Ⅰ~Ⅱ级的患者，全麻诱导期予丙泊酚0.5 mg·kg^-1·min^-1泵注速度分别滴定至OAAS评分4分、3分、2分、1分，达到1分后给予瑞芬太尼2 μg/kg、罗库溴铵0.6 mg/kg，2 min后进行气管插管，记录每个评分时的BIS值、平均动脉压（MAP）、心率（HR）及丙泊酚给药量，并分析OAAS评分与BIS值的相关性。采用ROC曲线分析BIS值在判断OAAS评分达到1分时的诊断效能。结果所有患者均顺利完成气管插管，不同OAAS评分对应的BIS值之间的存在差异（P<0.01），OAAS评分从5分至4分时，BIS值平均下降4.08；从4分至3分时下降8.32；从3分至2分时下降5.43；从2分至1分时下降5.24。OAAS评分与BIS值之间有显著相关（ρ=0.775，P<0.001）。OAAS评分1分对应的BIS值中位数为76，83.33%的患者BIS值超过60。ROC曲线分析显示，OAAS评分达到1分的最佳BIS截断值为84，敏感度为88.9%，特异度为73.3%，曲线下面积（AUC）为0.842（0.803~0.881）。结论全麻诱导期OAAS评分与BIS值具有较强的相关性，且OAAS评分具有较高的灵敏度和实时性，可有效弥补BIS监测延迟的不足。

关键词: 全麻诱导期, 丙泊酚, OAAS评分, 脑电双频谱指数, 监测延迟

Abstract:

Objective To explore the relationship between the Observer's Assessment of Alertness/Sedation (OAAS) score and the bispectral index (BIS) during propofol titration for general anesthesia induction and analyze the impact of BIS monitoring delay on anesthetic depth assessment. Methods This study was conducted among 90 patients (ASA class I-II) undergoing elective surgery under general anesthesia. For anesthesia induction, the patients received propofol titration at the rate of 0.5 mg·kg^-1·min^-1 till OAAS scores of 4, 3, 2, and 1 were reached. After achieving an OAAS score of 1, remifentanil (2 μg·kg⁻¹) and rocuronium (0.6 mg·kg⁻¹) were administered, and tracheal intubation was performed 2 min later. BIS values, mean arterial pressure (MAP), heart rate (HR), and propofol dosage at each OAAS score were recorded, and the correlation between OAAS scores and BIS values was analyzed. The diagnostic performance of BIS values for determining when the OAAS score reaches 1 was analyzed using ROC curve. Results All the patients successfully completed tracheal intubation. BIS values of the patients at each of the OAAS scores differed significantly (P<0.01), and the mean BIS value decreased by 4.08, 8.32, 5.43 and 5.24 as the OAAS score decreased from 5 to 4, from 4 to 3, from 3 to 2, and from 2 to 1, respectively. There was a significant correlation between the OAAS score and BIS values (ρ=0.775, P<0.001). The median BIS value for an OAAS score of 1 was 76, at which point 83.33% of the patients had BIS values exceeding 60. ROC curve analysis showed that for determining an OAAS score of 1, BIS value, at the optimal cutoff value of 84, had a sensitivity of 88.9%, a specificity of 73.3%, and an area under the curve of 0.842 (0.803-0.881). Conclusion OAAS score during induction of general anesthesia is strongly correlated with BIS value and is a highly sensitive and timely indicator to compensate for the delay in BIS monitoring.

Key words: general anesthesia induction, propofol, Observer's Assessment of Alertness/Sedation score, bispectral index, monitoring delay

陈丽红, 谢惠琳, 黄霞, 罗彤枫, 郭婧, 林春萌, 刘雪艳, 史李铄, 靳三庆. 观察者警觉/镇静评定评分与脑电双频谱指数监测在全麻诱导期丙泊酚滴定给药中的相关性[J]. 南方医科大学学报, 2025, 45(1): 52-58.

Lihong CHEN, Huilin XIE, Xia HUANG, Tongfeng LUO, Jing GUO, Chunmeng LIN, Xueyan LIU, Lishuo SHI, Sanqing JIN. Correlation between the Observer's Assessment of Alertness/Sedation score and bispectral index in patients receiving propofol titration during general anesthesia induction[J]. Journal of Southern Medical University, 2025, 45(1): 52-58.

图/表 6

表1 患者一般资料

Tab.1 General characteristics of the patients (n=90)

Characteristics	Result
Age (year)	43.52±11.25
Gender
Male	47 (52.2%)
Female	43(47.8%)
Body weight (kg)	62.48±10.47
Height (m)	1.65±0.08
BMI (kg·m^-2)	22.80±2.75
Hb (g·L^-1)	130.33±17.85
Alb (g·L^-1)	41.18±3.17
Dose of remifentanil (μg)	132.36±22.16
Dose of rocuronium (mg)	37.49±6.28
ASA Grade
1	5 (5.56%)
2	85 (94.44%)
NYHA grading
Ⅰ	30 (33.33%)
Ⅱ	60 (66.67%)

表2 OAAS评分达到不同评分时的患者情况

Tab.2 Parameters of the patients when OAAS score reaches different ratings (n=90)

OAAS score	BIS value	Titration time (s)	Dose of propofol (mg/kg)	MAP (mmHg)	HR (bpm)
5	96[94, 97]	-	-	99.14±11.23	80.37±13.32
4	93[87, 97]	120±34	1.00±0.27	91.66±10.92	79.74±11.34
3	82[80, 88]	163±39	1.35±0.32	87.01±10.87	78.77±10.44
2	79[74, 82]	188±45	1.56±0.37	83.60±10.85	78.64±10.52
1	76[66, 81]	206±49	1.70±0.41	82.39±11.25	77.78±10.63

图1 OAAS评分达到4.3.2.1分时丙泊酚千克体质量用药散点图

Fig.1 Scatter plots of propofol dosage per kilogram of body weight at OAAS scores of 4, 3, 2, and 1.

图2 OAAS评分4分、3分、2分、1分时对应BIS值散点图

Fig.2 Scatter plots of BIS values at OAAS scores of 4, 3, 2, and 1.

图3 OAAS评分5分、4分、3分、2分、1分时对应BIS值情况

Fig.3 BIS values at OAAS scores of 5, 4, 3, 2, and 1. Data are presented as median with interquartile range.

图4 BIS值预测患者OAAS评分达到1分的ROC曲线

Fig.4 ROC curve of BIS for predicting the time point when a patient's OAAS score reaches 1.

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观察者警觉/镇静评定评分与脑电双频谱指数监测在全麻诱导期丙泊酚滴定给药中的相关性

Correlation between the Observer's Assessment of Alertness/Sedation score and bispectral index in patients receiving propofol titration during general anesthesia induction

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