熵指数和脑电双频指数在学龄期儿童麻醉深度监测中的对比研究  

Comparative Study on Entropy and Bispectral Index in Monitoring Depth of Anesthesia in Children

作　　者：程宏霞[1] 王晓冬[2] 邱颐[2] 

机构地区：[1]内蒙古医科大学附属人民医院,内蒙古呼和浩特010010 [2]内蒙古医科大学第二附属医院麻醉科,内蒙古呼和浩特010030

出　　处：《内蒙古医学杂志》2016年第1期8-10,共3页Inner Mongolia Medical Journal

基　　金：内蒙古医科大学青年创新基金项目(YKD2013QNCX026)

摘　　要：目的比较熵指数（包括反应熵RE及状态熵SE）和脑电双频指数（BIS）在学龄期儿童麻醉深度监测中的有效性及可靠性,并验证二者是否可用于儿童氯胺酮麻醉深度监测,为提高其麻醉的安全性提供依据。方法择期骨科患儿上肢手术30例,6-12岁,体重18-35 kg,ASAⅠ级。患儿静脉滴注氯胺酮1.5 mg/kg,在神经刺激仪引导下行臂丛神经阻滞,静脉泵注丙泊酚5 mg/（kg·h）维持。观察入室基础值（T1）,意识消失即刻记录（T2）,切皮前30 s（T3）,切皮即刻（T4）,切皮后30 s（T5）,切皮后60 s（T6）时的心率、血压、RE、SE和BIS的变化情况是否相关。统计学方法：本例组内不同时间点的数据比较采用单因素方差分析,熵指数与BS相关性分析采用Pearson法,运用统计软件包SPSS13.0分析数据,以P〈0.05为差异有统计学意义。结果RE和SE在T4和T5时刻比T3明显升高,且升高幅度较BIS大,BIS在此刻无明显变化;RE和SE于T6降回到切皮前范围,BIS值此刻开始上升。RE分别与SE、BIS正相关,SE与BIS正相关。MAP和HR在切皮刺激下略有升高,但差异无统计学意义。结论熵指数和BIS均能对伤害性刺激做出反应,在监测镇静深度方面均有良好的作用,熵指数和BIS具有良好的相关性,由于RE和SE较BIS反应快速,故熵指数更适合实时监测麻醉深度。在同一麻醉深度水平,氯胺酮可使熵指数和BIS数值增加,故在学龄期儿童臂丛复合氯胺酮麻醉下,熵指数和BIS仅能反映麻醉深度的变化趋势,不可反应确切的麻醉深度。Objective The study tries to compare the validity and reliability of the entropy index（including RE and SE）and bispectral index in monitoring depth of anesthesia comparative study in school age children,and verify whether they can be used for children with ketamine anesthesia,in order to provide evidence for the safety of pediatric anesthesia.Methods To choose 30 cases ASAⅠschool-age children who are 6 to12 years old,undergoing elective orthopedic upper limb surgery,brachial plexus block compound ketamine.To observe the heart rate,blood pressure and entropy index（including RE and SE）and the change of the BIS,while base date（T1）,consciousness disappear immediately（T2）,cut the skin before 30s（T3）,cut the skin instantly（T4）,cut the skin after 30s（T5）,cut the skin after 60s（T6）,and to see if there is anything relevant.Results Compared with the RE and SE have risen obviously inT4 and T5,and more significant than the BIS,the BIS in this moment has no obvious change;RE and SE drop back to the level of T6,the BIS value began to rise this moment,P〈0.05.RE,SE and BIS are positive correlation,P〈0.01.MAP and HR under the skin cut stimulation rise slightly P〈0.05.Conclusion Entropy index and the BIS can respond to nociceptive stimulus,the changes are consistent with the changes in the depth of anesthesia,and entropy index and the BIS and has good correlation,the responses of RE and SE are more rapid than BIS,so the entropy index is more suitable for real-time monitoring of anesthetic depth.Ketamine can make the entropy index and BIS values increase at the same level of anesthesia,entropy index and the BIS can only reflect the change trend of anesthesia depth in school-age children under the brachial plexus compound ketamine anesthesia,and they do not tell the exact depth of anesthesia.

关 键 词：儿童 熵指数 脑电双频指数 麻醉深度 臂丛神经阻滞 

分 类 号：R614[医药卫生—麻醉学]