体外循环前与浅低温体外循环期间异丙酚麻醉脑频谱图比较分析  

Comparison and analysis of the electroencephalogram-spectrogram before and during mild hypothermic cardiopulmonary bypass under propofol anesthesia

作　　者：曲宗阳 周淑珍[1] 郑元庄 杨帆 华震[1] 杨宁[1] Qu Zongyang;Zhou Shuzhen;Zheng Yuanzhuang;Yang Fan;Hua Zhen;Yang Ning(Department of Anesthesiology,Bejing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Med ical Sciences,Beijing 100730,China;Zhejiang Pearlcare Medical Technology Co.,Lad,Hangzhou 310013,China;Department of Anesthesiology,Nanyuan Hospital,Bejing 100076,China)

机构地区：[1]北京医院麻醉科,国家老年医学中心,中国医学科学院老年医学研究所,北京100730 [2]浙江普可医疗科技有限公司,杭州310013 [3]北京市南苑医院麻醉科,北京100076

出　　处：《国际麻醉学与复苏杂志》2022年第8期834-839,共6页International Journal of Anesthesiology and Resuscitation

基　　金：北京医院121项目(BJ-2019-198)。

摘　　要：目的比较CPB前后异丙酚麻醉患者前额脑频谱图变化并分析其特征.方法纳入分析2019年5月—2020年9月29例异丙酚麻醉维持在CPB浅低温下进行冠状动脉旁路移植术的病例,比较CPB前与CPB浅低温阶段(约30℃)脑频谱图β波、α波、θ波、δ波能量,绘制CPB期间脑频谱图,重建CPB前与CPB浅低温阶段平均脑频谱图并进行比较,做差异谱分析描述两个阶段频谱变化.结果CPB期间脑频谱图呈现动态性变化,其中CPB浅低温阶段与CPB前相比,脑电θ波能量增强[2.8(1.9~3.9)dB,Z=-4.64,P<0.001],但β波能量[-3.4(-4.1~-2.6)dB,Z=-4.62,P<0.001]、α波能量[-2.9(-3.9~-2.0)dB,Z=-4.01,P<0.001]以及δ波能量[-1.5(-1.9~-0.9)dB,Z=-3.53,P<0.001]均减弱.前额脑频谱图可以直观地反映这种改变,降温时呈现动态α-θ频率减慢,复温时呈现动态α-θ频率增快.差异谱分析提示CPB浅低温状态时在4~8 Hz具有较高的能量[两个阶段间能量分布在4~8 Hz内差异有统计学意义(P<0.05)].结论脑频谱图在CPB浅低温阶段发生显著改变,θ波能量增强和β波、α波、δ波能量降低的脑频谱图可作为异丙酚维持输注CPB麻醉状态分析的参考.Objective To compare the prefrontal electroencephalogram-spectrogram before and during mild hypothermic cardiopulmonary bypass(CPB)under propofol anesthesia,and analyze its characteristics.Methods From May 2019 to September 2020,29 cases of coronary artery bypass grafting surgeries with propofol titration under mild hypothermic CPB were analyzed.This study comparedβ,α,e,and S wave powers between the pre-CPB state and mild hypothermic CPB state;this study plotted the electroencephalogram-spectrogram during the CPB procedure;average electroencephalogram-spectrograms of pre-CPB state and the mild hypothermic CPB state were reconstructed and compared;this study made a differential spectrum analysis todescribe the spectral change between these two states.ResultsElectroencephalogram-spectrograms were dynamic changing during CPB.Compared with baseline,mild hypothermia CPB state(at 30℃)increased in θ power[2.8(1.9,3.9)dB,Z=-4.64,P<0.001],but decreased in β power[-3.4(-4.1,-2.6)dB,Z=-4.62,P<0.001],α power[-2.9(-3.9,-2.0)dB,Z=-4.01,P<0.001]and δ power[-1.5(-1.9,-0.9)dB,Z=-3.53,P<0.001].The electroencephalogram-spectrograms intuitively displayed this change,it presented a dynamic decrease of frequency in the range ofα-e during cooling.and a dynamic increase of frequency in the range ofα-e during rewarming;the differential spectrum indicated that the state of mild hypothermic CPB had more power in the frequency within 4-8 Hz(P<0.05 in range of 4-8 Hz).Conclusions This study suggested that the electroencephalogram-spectrogram significantly changed during mild hypothermic CPB,the increase of θ power and the decrease of β,α,and δ powers might be regarded as a reference for judging the state of anesthesia in titrated propofol maintenance.

关 键 词：脑电图 体外循环 低温 

分 类 号：R614[医药卫生—麻醉学]