频谱熵用于神经外科围手术期意识水平监测的临床观察

Clinical Observation of Spectral Entropy Monitoring as A Measure of the Conscious State during Neurosurgical Operation

目的:探讨频谱熵用于神经外科围手术期意识水平监测的临床效果。方法:选择神经外科择期手术患者66例,随机分为:对照组(Ⅰ组,30例)和观察组(Ⅱ组,36例),切割硬脑膜均采用频谱熵和血流动力学监测。对照组依据血流动力学监测指标的变化,调整意识水平;而观察组则根据切割硬脑膜频谱熵指数调节意识水平。记录2组麻醉诱导前、插管后3min、切皮、切割硬脑膜和手术结束前10min平均动脉压(MAP)、心率(HR)、状态熵(SE)和反应熵(RE)值,麻醉复苏各项指标及麻醉药剂量。结果:插管后3min、切皮、切割硬脑膜、手术结束前10min,观察组SE和RE值均高于对照组,差异有统计学意义(P<0.05或P<0.01);而对照组MAP和HR明显低于观察组,差异有统计学意义(P<0.05或P<0.01)。观察组的麻醉复苏指标,包括自主呼吸、睁眼指令、拔管时间均较对照组显著缩短,且对照组麻醉剂用量高于观察组,差异有统计学意义(均P<0.01)。结论:频谱熵用于神经外科围手术期意识水平监测的临床效果优于血流动力学监测指标。

Objective： To evaluate the clinical effectiveness of conscious state–monitoring device based on time-fre- quency–balanced spectral entropy of electroencephalogram monitoring during neurosurgical operation. Methods： Sixty-six patients scheduled for elective neurosurgical operation were randomly divided into two groups： control group（Ⅰgroup, n = 30） and observation group（Ⅱgroup, n = 36）. Patients in control group were titrated to maintain adequate conscious state based on the monitoring of stable intraoperative hemodynamics. In the observation group, anesthetic was given to adjust to maintain the spectral entropy value to keep the adequate conscious state during operation. The values of mean arterial blood pressure （MAP）, heart rate （HR）, state entropy （SE） and response entropy （RE） were recorded before anesthesia induction, skin incision, at 3 min after intubation, at brain tissue dissection and during the last 10 min. And the parameters before recovery from anesthesia, the total amount of narcotic given were also recorded. Results： The values of SE and RE were significantly lower in the observation group than those in control group at 3 min after intubation, skin incision, at brain tissue dissection and during the last 10 min, whereas MAP and HR were higher in control group compared with those of the observation group （P 0.05 or P 0.01）. The recovery index including recovery time of spontaneous breathing, time to eye opening and extubation was signifi-cantly decreased in observation group than that in the control group （P 0.05 or P 0.01）. The total amount of narcotic consumption was significantly higher in the control group than that of the observation group （P 0.01）. Conclusion： During neurosurgical operation, the monitoring of conscious state by spectral entropy is more effective and better than hemodynamic standard practice.