熵指数监测下观察七氟烷在全麻过程中的应用

The usage of sevoflurane in the maintenance of anaesthesia with entropy as depth of anaesthesia monitor

目的:研究熵指数指导下七氟烷在全麻过程中的应用,并与丙泊酚进行比较,初步探讨熵指数与镇静/警觉评分(OAA/S评分)的相关性。方法:将40例ASAⅠ或Ⅱ级在全麻下行择期腹腔镜下胆囊切除术的患者分为七氟烷组和丙泊酚组,每组20例,麻醉期间分别采用七氟烷、雷米芬太尼和阿曲库铵或丙泊酚,雷米芬太尼和阿曲库铵维持。采用熵指数监测麻醉深度,将熵指数控制在40～60之间,术毕采用OAA/S评分反映患者全麻后意识恢复程度,并记录到达不同评分的时间及相应熵值(反应熵和状态熵),同时记录麻醉过程中及术毕清醒时对应的心率、平均动脉压(MAP)、脉搏血氧饱和度、呼气末二氧化碳,并计算比较两组参数的变化情况。结果:手术维持在同等熵指数下,切皮前两组MAP均高于术前,手术进行至10min时丙泊酚组的MAP持续升高,当30min时,丙泊酚组的SE值低于七氟烷组。手术结束苏醒时,最终到达OAA/S评分和定向力恢复时间,两组差异无统计学意义。结论:两组在麻醉维持有效性和安全性及苏醒时间上无明显差别,七氟烷的血流动力学稳定性优于丙泊酚,熵指数与OAA/S评分有良好相关性。

Objective To study the usage of sevoflurane in the maintenance of anaesthesia with entropy as depth of anaesthesia monitor,and to explore the relation between entropy and OAA/S score in compare with propofol. Methods Forty ASA Ⅰ or Ⅱ patients were choosed to undergo laparoscopic cholecystectomy in general anaesthesia, And the patients were divided into propofol group （n =20） and sevoflurane group （n =20）. During maintenance of anaesthesia procedures, propofol, remifentanil or sevoflurane were used to maintain anaesthesia with entropy as depth of anaesthesia monitor between 40 and 60. After the surgery was over, the level of consciousness was assessed with OAA/S score. And the time course to each OAA/S score, the values of HR, MAP, SpO2, PEXCO2, RE and SE were recored in the two groups. Results At the same depth of anaesthesia, MAP was increased in both two groups after the surgery was performed, 10 min later, the MAP was still high in the propofol group. 30 min later, the SE propofol group was lower than that of sevoflurane group. There was no statistically different in OAA/S score and recovery time in the two groups. Conclusions Both propofol and sevoflurane provided satisfactory and fast emergence anaesthesia for surgery. During anaesthesia surgical procedures,the haemodynamic of sevofluranel group is more stable than that of propofol group, and there is a good relation between entropy and OAA/S score.