熵指数对异丙酚麻醉中体动反应的预测  

Clinical study of relationships between spectral entropy and movement at skin incision during propofol anaesthesia

作　　者：毕素萍[1] 张宏[1] 贾宝森[1] 

机构地区：[1]解放军总医院麻醉科,北京100853

出　　处：《军医进修学院学报》2007年第4期276-278,共3页Academic Journal of Pla Postgraduate Medical School

摘　　要：目的:研究异丙酚麻醉中熵指数对于体动反应的预测并与双频谱指数比较。方法:ASA II级择期腹部手术患者20例,按对切皮有无体动反应分为体动组(8例)和非体动组(12例)。入室后常规监测,然后异丙酚、琥珀胆碱、芬太尼静脉注射快诱导气管插管,持续泵入异丙酚20 mg.kg-1.h-1,15 min后开始手术,如果患者发生切皮体动,则按10%提高下一个患者异丙酚输注速度,如果不动则按10%降低下一个患者异丙酚输注速度。每例患者同时行两种脑电监测,于以下时点记录指数:基础值、切皮前60s、切皮前30s、切皮后45s、120s。结果:熵指数值在两组之间有显著性差异(P<0.05),双频谱指数值在两组之间无显著性差异(P>0.05);熵指数可以预测切皮体动,其Pk值分别为0.8935和0.8872,BIS不能预测切皮体动,预测概率是0.5719,两种监测方法的预测概率之间有统计学差异(P<0.05);预测概率与熵指数的Logistic回归方程分别为lnPk/(1-Pk)=26.505-0.394x和lnPk/(1-Pk)=28.553-0.435x,熵指数的ED50是67,ED95是64。结论:熵指数能够预测异丙酚麻醉中的体动反应,能够反映麻醉的镇痛深度。Objective：To study if the spectral entropy can predict movement at skin incision during propofol anaesthesia and compare it with BIS. Methods：Twenty ASA Ⅱ patients undergoing elective abdominal surgery were studied. They were allocated into two groups of mover and non-mover according to whether they had response to skin incision or not. Anaesthesia was induced with propofol, succinylcholine and fentanyl and then was maintained with propofol at 20 mg ·kg^-1·h^-1 infusion rate. Operation began 15min later. The propofol infusion rate was decreased by 10 percent for the next patient if movement was not detected or increased by 10 percent if movement was detected. Each case was simutaneously monitered with spectral entropy and BIS. Data was recorded at following time： baseline values, 60 and 30s before skin incision, 45 and 120s after skin incision. Results：Entropy index had significant differences between two groups （P 〈 0.05）, but BIS index hadn＇ t （ P 〉 0. 05） ; Entropy index could predict movement with Pk of 0. 8935 and 0.8872 respectively but BIS couldnt with Pk of 0. 5719 ; logistic regressive equations of prediction probability and entropy index were In Pk/（ 1-Pk ） = 26. 505-0. 394x and In P/（ 1-Pk ） = 28.553-0. 435x respectively. Conclusion ：Entropy index can predict movement during propofol anaesthesia, which can reflect analgesic depth of anesthesia.

关 键 词：脑电描记术 熵指数 预测 概率 麻醉 恢复期 

分 类 号：R614.24[医药卫生—麻醉学]