CAJ | 학술논문

目的评价熵指数预测丙泊酚-瑞芬太尼全麻苏醒期意识恢复的准确性，并与脑电双频指数(BIS)进行比较。方法收集本院2010年10月至12月择期行妇科腹腔镜手术患者50例，采用靶控输注丙泊酚-瑞芬太尼维持麻醉。术后不同时点监测反应熵(RE)、状态熵(SE)、BIS、丙泊白酚效应室浓度(Ce)、平均动脉压(MAP)、心率(HR)，分别计算其预测苏醒期意识状态的预测概率(Pk)值并进行比较；分别计算5％、95％患者意识恢复时RE、SE、BIS等指标的有效数值（EC05、EC95）及其95％可信区间(95％CI)；分析RE、SE、BIS和Ce与苏醒期意识状态变化的相关性。结果RE、SE、BIS和Ce与苏醒期意识状态变化均具有相关性(rs=0.898、0.901、0.899、-0.935，均P＜0.01)。患者意识恢复时,RE、SE、BIS值分别为89.5±2.8、75.2±6.8、81.6±2.6；3者预测患者意识恢复的Pk值均显著高于0.5，亦高于MAP、HR的Pk值（均P＜0.01）。RE、SE、BIS的EC05及其95％CI分别为84.7(81.2，86.8)、58.3(52.5，61.1)、61.2(48.2，68.2),EC95及其95％CI分别为92.4(90.1,94.8)、72.2(67.5，78.2)、84.3(78.6，92.8)。90％患者意识恢复的RE范围最小，而BIS范围最大。结论熵指数和BIS均能准确预测丙泊酚-瑞芬太尼全麻苏醒期意识状态，熵指数比BIS能更准确预测患者意识恢复。
목적 평개적지수예측병박분-서분태니전마소성기의식회복적준학성，병여뇌전쌍빈지수(BIS)진행비교。방법 수집본원2010년10월지12월택기행부과복강경수술환자50례，채용파공수주병박분-서분태니유지마취。술후불동시점감측반응적(RE)、상태적(SE)、BIS、병박백분효응실농도(Ce)、평균동맥압(MAP)、심솔(HR)，분별계산기예측소성기의식상태적예측개솔(Pk)치병진행비교；분별계산5％、95％환자의식회복시RE、SE、BIS등지표적유효수치（EC05、EC95）급기95％가신구간(95％CI)；분석RE、SE、BIS화Ce여소성기의식상태변화적상관성。결과RE、SE、BIS화Ce여소성기의식상태변화균구유상관성(rs=0.898、0.901、0.899、-0.935，균P＜0.01)。환자의식회복시,RE、SE、BIS치분별위89.5±2.8、75.2±6.8、81.6±2.6；3자예측환자의식회복적Pk치균현저고우0.5，역고우MAP、HR적Pk치（균P＜0.01）。RE、SE、BIS적EC05급기95％CI분별위84.7(81.2，86.8)、58.3(52.5，61.1)、61.2(48.2，68.2),EC95급기95％CI분별위92.4(90.1,94.8)、72.2(67.5，78.2)、84.3(78.6，92.8)。90％환자의식회복적RE범위최소，이BIS범위최대。결론 적지수화BIS균능준학예측병박분-서분태니전마소성기의식상태，적지수비BIS능경준학예측환자의식회복。
Objective To evaluate the accuracy of prediction for consciousness using entropy index during recovery from propofol-remifentsnil general anesthesia as compared with brain bispoctral index (BIS).Methods Between October and December 2010, 50 patients undergoing selective gynecologic laparoscopic surgery under general anesthesia maintained with propofol-remifentanil by target-controlled infusion in our hospital were included in this study. The values of response entropy (RE), state entropy (SE), BIS, effectsite concentration of propofol (Ce), mean arterial pressure (MAP) and heart rate (HR) were monitored at different time points after operation, and the probabilities (Pk values) of throe prediction for conscionsness were calculated and compared. The EC05, EC95 values and 95％ CI for RE, SE and BIS at recovery of consciousness (ROC) were calculated, respectively. The correlations between RE, SE, BIS, Ce and changes in consciousness during recover were analyzed. Results There were significant correlations between RE, SE, BIS, Ce and consciousness during recovery from anesthesia (rs=0.898, 0.901, 0.899,and -0.935, all P＜0.01). The values of RE, SE and BIS at ROC were 89.5±2.8, 75.2±6.8, and 81.6±2.6,all with a Pk value higher than 0.5 and higher than those of MAP and HR (all P＜0.01 ). The EC05 values and 95％CI of RE, SE and BIS at ROC were 84.7(81.2,86.8), 58.3(52.5,61.1 ), and 61.2(48.2,68.2), and the EC95 values and 95％CI were 92.4(90.1,94.8), 72.2(67.5,78.2) and 84.3(78.6,92.8), respectively. Among 90％ of patients, the range of RE was smallest at ROC compared with the greatest range in BIS.Conclusions While both entropy index and BIS accurately predict consciousness during recovery from propofol-remifentanil general anesthesia, entropy index may be more effective than BIS in the prediction.