CAJ | 학술논문

目的评价脑电双频谱指数(BIS)和脑电熵指数监测全麻患者镇痛水平的可行性.方法择期全麻腹部手术患者26例,随机分为2组(n=13):试验组和对照组.常规监测行硬膜外置管后,试验组硬膜外注入1%利多卡因5 ml,对照组注入等量生理盐水,8 min后测定阻滞平面,根据结果试验组硬膜外追加1%利多卡因和0.5%罗哌卡因的混合制剂5～10 ml,对照组硬膜外追加生理盐水8 ml.麻醉诱导前确保试验组的感觉阻滞节段超过手术切口范围.连接BIS监测仪和脑电熵指数监测仪监测BIS、状态熵(SE)和反应熵(RE).靶控输注异丙酚(初始血浆靶浓度4 μg/ml)和瑞芬太尼(效应室靶浓度2 ng/ml)进行全麻诱导,调整异丙酚靶浓度,维持BIS 40～50.静脉注射罗库溴铵0.9 mg/kg,气管插管,机械通气,试验组停止输注瑞芬太尼,对照组继续输注瑞芬太尼,效应室靶浓度为2 ng/ml.切皮前3 min每分钟记录BIS、RE、SE、HR、SP、DP、MAP,取其平均值作为基础值,切皮后2 min内要求外科医师停止包括使用电刀在内的手术操作,每分钟记录上述指标.2 min后开始使用电刀,进行正常手术操作,并继续每分钟记录上述指标直到切皮后6 min,取其平均值.结果与基础值比较,切皮后1 min时对照组BIS、RE-SE、SP、DP和MAP均升高(P＜0.05),试验组各指标差异无统计学意义(P＞0.05),切皮后3～6 min内2组BIS、RE和RE-SE均升高,对照组BP升高(P＜0.05).切皮后1min.对于判断镇痛是否足够的准确性,△SP＞△RE-SE＞△MAP＞△BIS,判断准确性均中等.而在电刀干扰时,只有BP的变化可以作为判断指标区分不同的分组,△SP＞△MAP.结论 BIS、熵指数和BP并不能反映镇痛水平,但BIS、RE-SE和BP都能够在镇痛不足的情况下对伤害性刺激表现出明显升高.对于镇痛不足的判断准确性,△SP＞△RE-SE＞△BIS,准确性均中等.
목적 평개뇌전쌍빈보지수(BIS)화뇌전적지수감측전마환자진통수평적가행성.방법 택기전마복부수술환자26례,수궤분위2조(n=13):시험조화대조조.상규감측행경막외치관후,시험조경막외주입1%리다잡인5 ml,대조조주입등량생리염수,8 min후측정조체평면,근거결과시험조경막외추가1%리다잡인화0.5%라고잡인적혼합제제5～10 ml,대조조경막외추가생리염수8 ml.마취유도전학보시험조적감각조체절단초과수술절구범위.련접BIS감측의화뇌전적지수감측의감측BIS、상태적(SE)화반응적(RE).파공수주이병분(초시혈장파농도4 μg/ml)화서분태니(효응실파농도2 ng/ml)진행전마유도,조정이병분파농도,유지BIS 40～50.정맥주사라고추안0.9 mg/kg,기관삽관,궤계통기,시험조정지수주서분태니,대조조계속수주서분태니,효응실파농도위2 ng/ml.절피전3 min매분종기록BIS、RE、SE、HR、SP、DP、MAP,취기평균치작위기출치,절피후2 min내요구외과의사정지포괄사용전도재내적수술조작,매분종기록상술지표.2 min후개시사용전도,진행정상수술조작,병계속매분종기록상술지표직도절피후6 min,취기평균치.결과 여기출치비교,절피후1 min시대조조BIS、RE-SE、SP、DP화MAP균승고(P＜0.05),시험조각지표차이무통계학의의(P＞0.05),절피후3～6 min내2조BIS、RE화RE-SE균승고,대조조BP승고(P＜0.05).절피후1min.대우판단진통시부족구적준학성,△SP＞△RE-SE＞△MAP＞△BIS,판단준학성균중등.이재전도간우시,지유BP적변화가이작위판단지표구분불동적분조,△SP＞△MAP.결론 BIS、적지수화BP병불능반영진통수평,단BIS、RE-SE화BP도능구재진통불족적정황하대상해성자격표현출명현승고.대우진통불족적판단준학성,△SP＞△RE-SE＞△BIS,준학성균중등.
Objective To investigate the feasibility of using bispectral index(BIS)and entropy as measures of level of analgesia during general anesthesia.Methods After hospital ethics committee approval and written informed consent,26 ASA Ⅰ or Ⅱ patients aged 18-64 yr weighing 50-90 kg undergoing elective abdominal operation under general anesthesia were randomly allocated to one of 2 groups(n=13 each):experiment group (L)and control group(S).Epidural catheter was phced into epidural space at T9,10 interspace in both groups.Epidural placement was confirmed by a test dose of 1% lidocaine 5 ml and then a mixture of 1% lidocaine + 0.5% ropivaeaine 5-10 ml Was given epidurally in experiment group.The incision was within the sensory block area.While in control group equal volume of normal saline(NS)was given instead of lidocaine and ropivacaine.ECG,BP,HR,SpO2,BIS(Aspect,USA)and entropy[response entropy(RE),state entropy(SE)](Datex-Ohmeda.Finland)Were continuously monitored.General anesthesia was induced with TCI of propofol(initial target plasma concentration 4μg/ml)and TCI of remifentanil(target effect-site concentration 2 ng/ml).The target concentration of propofol was progressively increased until BIS value reached 40-50.Tracheal intubation was facilitated with rocuronium 0.9 mg/kg.After intubation remifentanil infusion was discontinued in experiment group but was continued(target effect site concentration 2 ng/ml)in control group.Skin incision was made about 20 min after tracbeal intubafion.BIS,RE,SE,BP(SP,DP,MAP)and HR were recorded every minute for 3 min before(baseline)until 6 min after skin incision.The surgeons were asked to wait for 2 min after skin incision without doing anything including electrocautery.Results At 1 min after skin incision,BIS,the difference between RE and SE(RE-SE)and BP were significandy increased as compared with the baseline in control group;while in experiment group there was no significant change in BIS,RE-SE and BP.When electrocantery was employed BIS,RE and RE-SE were significantly increased as compared with the baseline in both groups but BP was significantly increased only in control group.The area under the receiver operator characteristic curve(AUCROC)of the changes in all monitoring variables Was calculated to evaluate their diagnostic accuracy for inadequate analgesia.At 1 min after skin incision,△SP＞△RE-SE＞△MAP＞△BIS(moderate diagnostic accuracy).When electrocautery was employed,only the changes in BP had moderate diagnostic accuracy,△SP＞△MAP.Conclusion BIS,entropy and conventional hemodynarnic parameters can not predict the level of analgesia,but BIS,RE-SE and BP can respond to nociceptive stimulus during skin incision under inadequate analgesia.As the predictors of inadequate analgesia △SP＞△RE-SE＞△BIS,all have moderate diagnostic accuracy.