熵指数用于评价全身麻醉患者伤害性刺激强度的可行性分析  

Efficacy of Entropy Index in Monitoring Nociceptive Stimulus in Patients Undergoing Propofol-remifentanil General Anesthesia

作　　者：薛照静 权翔[1] 赵晶[1] 黄宇光[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院麻醉科,北京100730

出　　处：《中国医学科学院学报》2014年第1期68-72,共5页Acta Academiae Medicinae Sinicae

摘　　要：目的 评价熵指数（RE/SE）监测异丙酚＋瑞芬太尼静脉全身麻醉患者伤害性刺激强度的可行性.方法 选择18～65岁择期行下腹部手术、美国麻醉协会（ASA）分级为Ⅰ～Ⅱ级的全身麻醉患者60例,根据麻醉诱导时瑞芬太尼的不同输注浓度随机分为两组：瑞芬太尼浓度在气管插管前由0 ng/ml变为1 ng/ml（A组）和瑞芬太尼浓度始终维持在3 ng/ml（B组）.在指定时间先后给予80 mA强直电刺激（T2）、气管插管刺激（T12）及切皮刺激（T12＇）.分别比较反应熵（RE）和状态熵（SE）在3种不同程度刺激前后的变化.结果 12例患者因使用血管活性药物而退出本研究,A组实验对象为28例,B组实验对象20例.强直电刺激前后,RE和SE在两组内均无明显变化（P均＞0.05）;气管插管后,B组RE和SE较插管前明显升高（P均＜0.05）,A组无明显变化（P均＞0.05）;切皮刺激后,两组RE和SE较切皮前均明显升高（P均＜0.05）.同一刺激条件下,RE和SE在不同瑞芬太尼药物浓度组间差异无统计学意义（P均＞0.05）.结论 在异丙酚＋瑞芬太尼麻醉下,伤害性刺激可导致RE和SE不同程度的增高,RE/SE可作为全身麻醉患者伤害性刺激强度的反映指标.Objective To evaluate the efficacy of reflex entropy （RE） /state entropy （SE） in moni- toring the response to noeiceptive stimulus during propofol-remifentanil infusion. Methods After the approval of the hospital ethics committee, sixty American Society of Anesthesiologists （ASA） classification Ⅰ - Ⅱ patients, aged 18-65 years, receiving the hypogastrium operation undergoing general anesthesia, were randomly allocated to groups A and B with different remifentanil concentrations. After the concentration of propofol and remifentanil reached balance, tetanic stimulation, intubation, and incision were performed respectively with certain inter- vals. RE and SE were monitored during this procedure. Results Twelve patients were withdrawn from this study due to the use of vasoactive drugs. Finally, there were 28 cases in group A and 20 cases in group B. The RE and SE were not significantly changed before and after the tetanic stimulation in both groups （ all P 〉 0. 05 ）. Both RE and SE were significantly increased after intubation in group B （ both P 〈 0. 05 ） and after skin incision in both groups （ all P 〈 0. 05 ）. Under the same stimulation, RE and SE showed no significant difference among groups administered with different levels of remifentanil （ P 〉 0.05 ）. Conclusion Under the anesthesia with propofol ＋ remifentanil, nociceptive response may cause the increase of RE and SE. Therefore, RE and SE may be useful parameters for monitoring the nociceptive response during general anaesthesia.

关 键 词：伤害性刺激 熵指数 全身麻醉 刺激强度 

分 类 号：R445.2[医药卫生—影像医学与核医学]