脑电双频指数辅助监测的静脉镇静用于胃食管反流病射频治疗的研究*

Efficacy of bispectral index monitoring as an adjunct to sedation for endoluminal radiofrequency ablation in patients with gastroesophageal reflux disease: a randomized clinical trial*

摘要:

探讨脑电双频指数（BIS）辅助监测的静脉镇静用于内镜下胃食管反流病（GERD）射频治疗的效果。方法?将拟行静脉镇静下内镜射频治疗GERD的成年患者90例随机等分为常规镇静组（control）和BIS辅助镇静组（BIS）。两组均采用右美托咪定、舒芬太尼和丙泊酚复合镇静。control组采用常规临床观察改良警觉/镇静评分（MOAA/S）判定镇静深度，实施镇静；BIS组采用在临床观察的基础上，将BIS值控制在55～70。观察比较两组患者镇静相关的不良事件（血压和心率节律异常、缺氧、体动反应）发生率、血流动力学变化、镇静深度、丙泊酚用量和医患满意度。结果?与control组相比，BIS组体动反应发生率更低（P?=0.030）；两组循环、呼吸不良事件发生率相似（P?>0.05），术中心率、血压和血氧饱和度（SpO2）差异无统计学意义（P?>0.05）。BIS组MOAA/S（P?=0.018）和BIS值（P?=0.000）高于、丙泊酚用量低于（P?=0.016）、医生满意度（P?=0.007）高于control组。两组患者满意度相似（P?=0.243）。结论?BIS辅助监测的镇静有助于减少内镜下GERD射频治疗过程中的体动反应，提高操作者满意度和减少镇静药物丙泊酚用量，避免过度镇静。

Abstract:

To investigate the efficacy of adjunctive use of bispectral index (BIS) monitoring to titrate sedation for endoscopic radiofrequency management of gastroesophageal reflux disease (GERD).?Methods?Ninety patients underwent elective endoluminal radiofrequency ablation for GERD under sedation were prospectively randomized divided into two groups with the BIS value either visible (BIS group, n?=?45) or invisible (control group, n?=?45) to the anesthesiologist. Patients in both groups received propofol as the main drug for sedation with adjunctive use of dexmedetomidine and sufentanil. Sedation depth was monitored according to routine practice using the modified Observer’s Assessment of Alertness/Sedation (MOAA/S) Scale (MOAA/S score 0 to 1). In the BIS group, the anesthesiologist also used the BIS value for titration of sedation, and targeted BIS values between 55 and 70. The incidences of sedation-related adverse events (including body movement, abnormal blood pressure, bradycardia, tachycardia, arrhythmia and hypoxemia), hemodynamic stability, the depth of sedation, the doses of propofol administered, and the satisfaction scores (scale of 0?~?10) of patients and endoscopists were compared between groups.?Results?A low incidence of body movement was observed in the BIS group compared with control (P?=?0.030) with no between-group differences in the incidences of cardiopulmonary adverse events, heart rates, blood pressure or oxygen saturation ( all P?>?0.05). MOAA/S (P?=?0.018) and BIS value (P?=?0.000) were higher, propofol consumption was less (P?=?0.034) and endoscopists’ satisfaction score (P?=?0.007) was higher in the BIS group compared with those in control. No difference was found for patients’ satisfaction score (P?=?0.243).?Conclusions?BIS-assisted sedation for endoscopic radiofrequency management of GERD was superior to sedation titrated by routine clinical practice with less body movements, higher endoscopists’ satisfaction score, lower consumption of sedatives and lighter depth of sedation.