熵指数和双频指数用于监测伤害性刺激反应的比较  

Comparing entrory and bispectral index ability to monitor noxious stimulus during propofol-fentanyl-vecuronium anesthesia

作　　者：李倩[1] 王春林[1] 米智华[1] 

机构地区：[1]江苏省苏北人民医院麻醉科,江苏扬州225001

出　　处：《实用临床医药杂志》2012年第22期106-108,共3页Journal of Clinical Medicine in Practice

基　　金：江苏省扬州市社会发展计划基金资助项目(YZS2007005)

摘　　要：目的比较熵指数(RE、SE)和双频指数(BIS)在丙泊酚-芬太尼-维库溴铵麻醉下监测气管插管和手术切皮伤害性刺激的能力。方法选择ASAⅠ～Ⅱ级择期行腹腔镜胆囊切除术患者21例。行麻醉诱导和麻醉维持。观察麻醉诱导前即基础值(T1)、患者对指令性反应消失(T2)、气管插管即刻(T3)、插管后第1分钟(T4)、切皮即刻(T5)和切皮后第1分钟(T6)六个时点RE、SE、BIS、△RE-SE、平均动脉压(MAP)和心率(HR)的变化。结果插管后第1分钟MAP显著高于插管时(P<0.01),但显著低于基础值(P<0.01),手术切皮前后MAP无显著变化(P>0.05);插管前后和切皮前后HR均无显著变化(P>0.05)。RE、SE、△RE-SE和BIS在插管前后和切皮前后差异无统计学意义。结论在丙泊酚-芬太尼-维库溴铵麻醉下,熵指数和BIS对气管插管以及切皮伤害性刺激反应均缺乏有效的监测作用。Objective To compare entropy （RE, SE） and bispectral index （BIS） ability to monitor noxious stimuli during propofol-fentany-vecuronium anesthesia. Methods Twenty-one ASA Ⅰ-Ⅱ patients scheduled for elective laparoscopic cholecystectomy were included in this study. Anes- thesia was induced and endotracheal intubation was performed. RE, SE, ARE-SE （the difference between RE and SE）, BIS, the mean arterial pressure （MAP）, and the heart rate （HR） were recorded respectively during 6 specific events： pre-induction （baseline） （T1）, loss of responses to command（T2）, tracheal intubation （T3）, 1 min after intubation （T4）, skin incision （T5）, and 1 min after skin incision （T6）. Results Compared with tracheal intubation value, MAP increased sig- nificantly after intubation（P〈 0.01）, but significantly decreased compared with baseline （P〈 0. 01）, and there was no significant changes during skin incision （P〉0.05）. HR decreased significantly after induction, while there was no significant changes during intubation and skin incision （P〉0.05）. RE, SE, ZXRE-SE and BIS values decreased significantly after induction, and there was no significant differences during intubation and skin incision （P〉0.05）. Conclusion Entropy and BIS may lack sensitivity to the noxious stimulis of the intubation and the incision during propofol-fentany-vecuronium anesthesia.

关 键 词：熵指数 双频指数 丙泊酚 芬太尼 维库溴铵 伤害性刺激 

分 类 号：R614[医药卫生—麻醉学]