體位因素對(duì)全麻患者熵指數(shù)和腦電雙頻指數(shù)的影響
發(fā)布時(shí)間：2018-09-13 09:05
【摘要】：目的：觀察全麻患者同一麻醉深度不同體位下熵指數(shù)及腦電雙頻指數(shù)的變化,探討體位因素對(duì)熵指數(shù)和腦電雙頻指數(shù)的影響,評(píng)價(jià)二者用于監(jiān)測(cè)手術(shù)患者體位變化時(shí)麻醉深度的準(zhǔn)確性。方法：采用自身對(duì)照的研究方法。擇期行全麻手術(shù)患者120例,年齡25-55歲,體重指數(shù)18～24kg/m2, ASA分級(jí)I-II級(jí)�；颊呷胧液蟊O(jiān)測(cè)平均動(dòng)脈壓(MAP)、心率(HR)、血氧飽和度(Sp02)、呼氣未二氧化碳(EtCO2)、狀態(tài)熵(SE)、反應(yīng)熵(RE)及腦電雙頻指數(shù)(BIS)。霧化吸入2%利多卡因后,靶控輸注丙泊酚和瑞芬太尼,效應(yīng)室濃度分別為3ug/ml.4ng/ml,意識(shí)消失后行纖支鏡引導(dǎo)氣管插管。插管成功后停止輸注瑞芬太尼,將丙泊酚的靶控濃度調(diào)至4ug/ml。待丙泊酚維持穩(wěn)態(tài)靶控濃度后10min,間隔5min記錄RE、SE、BIS值及HR、MAP、EtC02、SpO2,即達(dá)到穩(wěn)態(tài)靶控濃度的10min、 15min、20min記錄,取三次數(shù)值的平均值。調(diào)整患者體位,將患者分別置于頭低腳高位30。、平臥位、頭高腳低位30。,每個(gè)體位保持15min,間隔5min記錄RE、SE、 BIS值及HR、MAP、EtCO2、SpO2,取三次數(shù)值的平均值。于術(shù)后第一天及術(shù)后一周回訪并記錄術(shù)中知曉發(fā)生情況。結(jié)果：(1)術(shù)后回訪無(wú)患者發(fā)生術(shù)中知曉,所有受試患者未出現(xiàn)藥物過(guò)敏或其他不良反應(yīng)。(2)不同體位患者HR、MAP、EtCO2. SpO2無(wú)明顯變化,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(3)平臥位時(shí)BIS、SE、RE值分別為46.4±3.9、47.8±4.3、49.8±2.5,頭低腳高位時(shí)分別為48.4±4.5、49.2±3.8、50.0±3.7,重置平臥位時(shí)BIS、SE、RE值分別為46.4±5.0、47.8±3.8、49.8±2.1,頭高腳低位時(shí)分別為45.5±4.5、47.0±2.6、49.8±3.2。兩次平臥位BIS、SE、RE值比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；與平臥位比較,頭低腳高位BIS值、SE值顯著升高(P0.05),RE值差異無(wú)統(tǒng)計(jì)學(xué)意義；與平臥位比較,頭高腳低位BIS值、SE值顯著降低(P0.05),RE值差異無(wú)統(tǒng)計(jì)學(xué)意義；與頭低腳高位比較,頭高腳低位BIS值、SE值顯著降低(P0.05),RE值差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論：體位因素對(duì)熵指數(shù)的影響小于對(duì)腦電雙頻指數(shù)的影響,與腦電雙頻指數(shù)相比,熵指數(shù)用于手術(shù)患者體位變化時(shí)麻醉深度監(jiān)測(cè)更準(zhǔn)確。
[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 鹵3.9 鹵4.3U 49.8 鹵2.5, those in high head and low foot were 48.4 鹵4.5 鹵3.8 鹵50.0 鹵3.7, in resetting supine position were 46.4 鹵5.047.8 鹵3.89.8 鹵2.1 and 45.5 鹵4.57.0 鹵2.69,49.8 鹵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.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R614
本文編號(hào)：2240696
[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 鹵3.9 鹵4.3U 49.8 鹵2.5, those in high head and low foot were 48.4 鹵4.5 鹵3.8 鹵50.0 鹵3.7, in resetting supine position were 46.4 鹵5.047.8 鹵3.89.8 鹵2.1 and 45.5 鹵4.57.0 鹵2.69,49.8 鹵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.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R614
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