摘要
目的评估基于样本熵(sample entropy,SampEn)等脑电参数的麻醉深度指数(depth of anesthesia index,Ai)在全凭静脉麻醉中反映意识状态的情况。方法将Ai和BIS的电极片通过随机数字表法随机贴于同一患者前额的左右两侧。血浆靶控输注丙泊酚以每分钟增加0.5mg/L的速度增加直至患者意识消失loss of consciousness,LOC).记录麻醉诱导和麻醉复苏过程中丙泊酚效应室浓度(effect-site concentration,Ce)、Ai和BIS数值并比较分析。通过Logistic回归模型分析意识状态和Ai、BIS的相关性。结果6家医院144例患者顺利完成实验。LOC时Ai为61±12、BIS为62±11,LOC后1min内Ai减少15.0%、BIS减少9.3%;意识恢复(recovery of consciousness,ROC)时Ai为74±14、BIS为76±8,ROC后1min内Ai增加15.0%、BIS增加7.0%。95%LOC时Ai为48.3、BIS为52.3;5%ROC时Ai为55.7、BIS为63.1。结论在LOC时和ROC时,以及用Logistic回归模型预测50%LOC和50%ROC时,Ai对比BIS二者的差距均很小,在临床判断麻醉深度上没有差别。在意识的变化过程中,Ai的改变比BIS更明显,更能反映意识的改变。
Objective To evaluate the validity of the depth of anesthesia index (Ai),based on sample entropy of electroencephalogram,in identifying the status of the consciousness during total intravenous anesthesia.Methods EEG electrode strips for recording Ai and BIS were randomly positioned on the left or right side of each patient's forehead.Target-controlled infusion of propofol was increased by 0.5mg/L per minute in a stepwise manner until loss of consciousness (LOC)was achieved.Values of Ai, BIS and estimated effect-site concentration (Ce)of propofol were recorded and analyzed during induction and emergence of general anesthesia.Logistic regression was used to analyze the relationship between consciousness state and values of Ai or BIS.Results One hundred and forty four patients in six medical centers were enrolled and have accomplished this protocol safely.In patients at LOC,the values of Ai and BIS were 61±12and 62±11,which were respectively reduced by 15.0%and 9.3%one minute after LOC. When patients regained consciousness (ROC),Ai and BIS respectively reached 74±14and 76±8,and increased by 15.0% and 7.0%,correspondingly,one minute after ROC.The estimated values of Ai and BIS were 48.3 and 52.3 for 95% LOC,and were 55.7 and 63. 1for 5%ROC.Conclusions At LOC,ROC,estimated 50% LOC and 50% ROC,the values of Ai and BIS were close to each other and they are equivalent for clinical monitoring.When consciousness states altered,changes of Ai were significantly greater than those of BIS.It suggests that Ai is a better parameter to estimate alterations of consciousness state.
作者
付阳
许涛
谢克亮
魏威
高萍
聂煌
邓小明
王国林
田鸣
严敏
董海龙
岳云
Fu Yang;Xu Tao;Xie Keliang;Wei Wei;Gao Ping;Nie Huang;Deng Xiaoming;Wang Guolin;Tian Ming;Yan Min;Dong Hailong;Yue Yun(Department of Anesthesiology,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100020,China;Faculty of Anesthesiology,Changhai Hospital,Naval Military Medical University,Shanghai 200433,China;Department of Anesthesiology,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Anesthesiology,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing 100050,China;Department of Anesthesiology,the Second Affiliated Hospital of Zhejiang University Medical College,Hangzhou 310009,China;Department of Anesthesiology,Xijing Hospital Affiliated to the Fourth Military Medical University,Xi'an 710032,China)
出处
《国际麻醉学与复苏杂志》
CAS
2018年第11期1005-1009,共5页
International Journal of Anesthesiology and Resuscitation
关键词
意识消失
意识恢复
全凭静脉麻醉
麻醉深度指数
脑电双频指数
Loss of consciousness
Recovery of consciousness
Total intravenous anesthesia
Depth of anesthesia index
Bispectral index
