体位因素对全麻患者熵指数和脑电双频指数的影响

发布时间：2018-09-13 09:05

【摘要】：目的：观察全麻患者同一麻醉深度不同体位下熵指数及脑电双频指数的变化,探讨体位因素对熵指数和脑电双频指数的影响,评价二者用于监测手术患者体位变化时麻醉深度的准确性。方法：采用自身对照的研究方法。择期行全麻手术患者120例,年龄25-55岁,体重指数18～24kg/m2, ASA分级I-II级。患者入室后监测平均动脉压(MAP)、心率(HR)、血氧饱和度(Sp02)、呼气未二氧化碳(EtCO2)、状态熵(SE)、反应熵(RE)及脑电双频指数(BIS)。雾化吸入2%利多卡因后,靶控输注丙泊酚和瑞芬太尼,效应室浓度分别为3ug/ml.4ng/ml,意识消失后行纤支镜引导气管插管。插管成功后停止输注瑞芬太尼,将丙泊酚的靶控浓度调至4ug/ml。待丙泊酚维持稳态靶控浓度后10min,间隔5min记录RE、SE、BIS值及HR、MAP、EtC02、SpO2,即达到稳态靶控浓度的10min、 15min、20min记录,取三次数值的平均值。调整患者体位,将患者分别置于头低脚高位30。、平卧位、头高脚低位30。,每个体位保持15min,间隔5min记录RE、SE、 BIS值及HR、MAP、EtCO2、SpO2,取三次数值的平均值。于术后第一天及术后一周回访并记录术中知晓发生情况。结果：(1)术后回访无患者发生术中知晓,所有受试患者未出现药物过敏或其他不良反应。(2)不同体位患者HR、MAP、EtCO2. SpO2无明显变化,差异无统计学意义(P0.05)。(3)平卧位时BIS、SE、RE值分别为46.4±3.9、47.8±4.3、49.8±2.5,头低脚高位时分别为48.4±4.5、49.2±3.8、50.0±3.7,重置平卧位时BIS、SE、RE值分别为46.4±5.0、47.8±3.8、49.8±2.1,头高脚低位时分别为45.5±4.5、47.0±2.6、49.8±3.2。两次平卧位BIS、SE、RE值比较,差异无统计学意义(P0.05)；与平卧位比较,头低脚高位BIS值、SE值显著升高(P0.05),RE值差异无统计学意义；与平卧位比较,头高脚低位BIS值、SE值显著降低(P0.05),RE值差异无统计学意义；与头低脚高位比较,头高脚低位BIS值、SE值显著降低(P0.05),RE值差异无统计学意义。结论：体位因素对熵指数的影响小于对脑电双频指数的影响,与脑电双频指数相比,熵指数用于手术患者体位变化时麻醉深度监测更准确。
[Abstract]:Objective: to observe the changes of entropy index and bispectral index of EEG in different positions of patients with general anesthesia under the same anesthetic depth, and to explore the effect of postural factors on entropy index and bispectral index of EEG. To evaluate the accuracy of the two methods in monitoring the depth of anesthesia in patients undergoing surgery. Methods: a self-controlled study was used. 120 patients, aged 25 to 55 years, undergoing elective general anesthesia, had a body mass index of 18 ~ 24 kg / m ~ (2) and ASA grade of I-II. The mean arterial pressure (MAP), blood oxygen saturation (Sp02), non-expiratory carbon dioxide (EtCO2), entropy of state (SE), response entropy (RE) and bispectral index (BIS). Were monitored after entering the room. After inhalation of 2% lidocaine, target controlled infusion of propofol and remifentanil was performed. The concentration of effector chamber was 3ugr / ml. 4 ng / ml, respectively. The tracheal intubation was guided by fiberoptic bronchoscope after consciousness disappeared. After successful intubation, the infusion of remifentanil was stopped and the target control concentration of propofol was adjusted to 4ugr / ml. When propofol maintained the steady-state target control concentration for 10 min, the interval 5min recorded the RE,SE,BIS value and the HR,MAP,EtC02,SpO2, value reached the steady-state target control concentration for 10 min, 15 min and 20 min respectively. The average value of the third order value was obtained. The patients were placed in the high position of lower head foot 30.the position of supine and the position of low foot of the head respectively. Each position was maintained for 15 minutes. The mean values of RE,SE, BIS and HR,MAP,EtCO2,SpO2, were recorded at intervals of 5min and the average value of HR,MAP,EtCO2,SpO2, was taken three times. Visit back on the first day and week after operation and record the occurrence of intraoperative knowledge. Results: (1) there was no intraoperative knowledge of the patients in the follow-up visit, and no drug allergy or other adverse reactions were found in all the patients. (2) HR,MAP,EtCO2. was found in patients with different postures. There was no significant change in SpO2 (P0.05). (3) BIS,SE,RE values in supine position were 46.4 卤3.9 卤4.3U 49.8 卤2.5, those in high head and low foot were 48.4 卤4.5 卤3.8 卤50.0 卤3.7, in resetting supine position were 46.4 卤5.047.8 卤3.89.8 卤2.1 and 45.5 卤4.57.0 卤2.69,49.8 卤3.2 respectively in supine position. There was no significant difference in BIS,SE,RE between the two supine positions (P0.05); compared with the supine position, the BIS value of the head and lower foot increased significantly (P0.05), and there was no significant difference in RE value between the two supine positions (P0.05), and compared with the supine position, there was no significant difference in RE value. The SE value of head high foot low BIS value was significantly lower than that of head lower foot BIS value (P 0.05), and there was no significant difference between head high foot low BIS value and head lower foot BIS value (P 0.05). Conclusion: the effect of postural factors on entropy index is less than that on bispectral index of EEG. Compared with bispectral index of EEG, entropy index is more accurate in monitoring the depth of anesthesia in patients undergoing operation.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614

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