基于听觉诱发电位的脑电信号监测意识状态指数在高位截瘫患者手术中麻醉深度调控效应的评价  

Evaluation of the consciousness state index based on auditory evoked potentials for monitoring anesthetic depth in surgeries for patients with high-level paraplegia

作　　者：邹润林 莫志伟 卢燕 周建玲 ZOU Run-lin;MO Zhi-wei;LU Yan;ZHOU Jian-ling(Department of Anesthesiology,Chinese Medicine Hospital of Gaozhou City,Gaozhou 525200,Guangdong,China)

机构地区：[1]高州市中医院麻醉科,广东高州525200

出　　处：《广东医学》2025年第1期113-118,共6页Guangdong Medical Journal

基　　金：高州市科技局医学科研课题(220321154551757)。

摘　　要：目的应用听觉诱发电位的脑电信号监测意识状态指数(CSI)监测高位截瘫患者手术麻醉深度,评价其监测调控临床应用的价值。方法将高州市中医院于2022年4月至2024年2月收治的30例高位截瘫手术麻醉患者作为研究对象,按照数字抽签法电脑排序随机分为研究组(A组)与对照组(C组),每组15例,两组同样监测CSI;C组由麻醉医师根据临床经验判断麻醉深度,并调整麻醉用药;A组根据CSI麻醉深度指数调整麻醉用药。记录患者不同时间的心电图(ECG)、平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO_(2))和CSI;其时间点包括入手术室后10 min(T0)、插管(T1)、皮肤切开(T2)、手术探查(T3)、手术结束(T4)、意识恢复时(T5)及离开手术室前(T6);同时,记录两组患者恢复意识的时间,评估术中并发症;记录不良反应情况(包括苏醒延迟、恶心呕吐、躁动、呛咳、术中知晓和术后认识障碍等),对比两组麻醉效应。结果两组患者一般情况及在T0和T1时刻MAP、HR、SpO_(2)基本相似,组间比较差异无统计学意义(P>0.05);在T2、T3、T4、T5和T6时间点中,A组的生命体征(MAP、HR、SpO_(2))更为平稳,波动幅度明显小于C组,组间比较差异有统计学意义(P<0.05)。在T0时间点A组与C组的CSI值基本相同,组间比较差异无统计学意义(P>0.05),在T1、T2、T3、T4、T5和T6时间节点中A组CSI值明显高于C组,组间比较差异有统计学意义(P<0.05)。A组苏醒时间、术中低血压、术中知晓发生率显著低于C组,组间比较差异有统计学意义(P<0.05)。结论基于听觉诱发电位的脑电信号监测CSI,能够充分发挥麻醉深度监测的优势作用,为高位截瘫患者手术麻醉提供可靠的用药方案,有利于患者生命体征的稳定,可减少不良反应和术中知晓发生率,提高患者麻醉的安全性,值得临床选用。Objective To evaluate the efficacy of the consciousness state index(CSI)based on auditory evoked potentials(AEP)for monitoring anesthetic depth during surgeries for patients with high-level paraplegia.Methods Thirty patients undergoing anesthesia for high-level paraplegia surgery at Chinese Medicine Hospital of Gaozhou City from April 2022 to February 2024 were enrolled and randomly divided into a study group(Group A)and a control group(Group C),with 15 patients in each group.CSI monitoring was used in both groups.Anesthesia depth in Group C was adjusted based on the anesthesiologist′s clinical judgment,while Group A adjusted anesthetic dosages based on CSI readings.Parameters including electrocardiogram(ECG),mean arterial pressure(MAP),heart rate(HR),oxygen saturation(SpO_(2)),and CSI were recorded at various time points:10 minutes after entering the operating room(T0),intubation(T1),skin incision(T2),surgical exploration(T3),end of surgery(T4),recovery of consciousness(T5),and just before leaving the operating room(T6).Awakening time,intraoperative complications,and adverse reactions(delayed recovery,nausea,vomiting,agitation,coughing,intraoperative awareness,and postoperative cognitive impairment)were compared between the two groups.Results No significant differences were found in MAP,HR,or SpO_(2)between Groups A and C at T0 and T1(P>0.05).However,at T2,T3,T4,T5,and T6,Group A exhibited more stable vital signs,with significantly smaller fluctuations compared to Group C(P<0.05).The CSI values at T0 were similar in both groups(P>0.05),but were significantly higher in Group A than Group C at T1,T2,T3,T4,T5,and T6(P<0.05).Group A showed shorter awakening times and lower incidences of intraoperative hypotension and awareness compared to Group C(P<0.05).Conclusion Monitoring anesthetic depth using CSI based on AEP offers significant advantages for anesthesia management in surgeries for high-level paraplegia.This approach stabilizes vital signs,reduces adverse reactions and intraoperative awareness,and enhances an

关 键 词：听觉诱发电位 脑电信号 意识状态指数 高位截瘫 

分 类 号：R614.2[医药卫生—麻醉学] R971.2[医药卫生—外科学]