小波指数用于麻醉深度监测的研究

Comparative investigation of wavelet index and bispectral index in monitoring depth of anesthesia

目的研究在靶控联合输注丙泊酚和雷米芬太尼时小波指数(wavelet index,WLI)监测麻醉深度的可行性。方法选择30例行腹腔镜胆囊切除或妇科腹腔镜手术的全麻患者。全麻诱导采用血浆浓度靶控输注丙泊酚,从1.5μg/ml开始,达到浓度后1min增加0.5μg/ml,最终达到4.0μg/ml,于切皮前5min开始靶控输注雷米芬太尼4.0ng/ml,至开始缝皮时停止靶控输注丙泊酚和雷米芬太尼。患者麻醉全程同时监测WLI和BIS值。结果随着诱导过程中靶控丙泊酚血浆浓度的增加,WLI和BIS值均呈下降趋势(P<0.05),丙泊酚血浆靶浓度为0、1.5、4.0μg/ml时,WLI较BIS值明显升高(P<0.01)。缝皮停药后WLI和BIS值均呈上升趋势(P<0.05),与BIS值比较,停药后1～6minWLI明显升高(P<0.01)。意识消失时WLI(57.8±6.7)和BIS值(57.7±5.7)差异无统计学意义。意识恢复时WLI(82.4±5.9)明显高于BIS值(76.3±5.5)(P<0.01)。经Bland-Altman一致性分析,WLI和BIS在诱导和苏醒期间一致性在可接受范围内(偏差为-4.2,2SD为11.7%和-24.7%)。结论在靶控输注丙泊酚和雷米芬太尼进行全麻时,WLI具有和BIS相似的麻醉深度监测作用。

Objective To investigate the feasibility of wavelet index（WLI） to monitor the depth of anesthesia compare with BIS during target controlled infusion of propofol and remifentanyl. Methods Thirty ASA grade Ⅰ or Ⅱ patients scheduled for laparoscopic cholecystectomy or laparoscopic operation of gynecology were enrolled in this study. Each patient was monitored by both BIS and WLI at the same time. Anesthesia was induced with TCI propofol （plasm site concentration was set at 1.5 g/ml until 4.0 g/ml）, and rocuronium. Then it was maintained with TCI propofol and remifentanyl and intermittent i.v. boluses of rocuroniurru WI.I and B1S were continuously monitored during operation. Results WI.I and BIS had significant effective with propofol plasm-site concentration. Both of them are inverse correlation with propofol plasm site concentration （rHLS = --0. 977, rWLI=-0. 984）. The correlation between WLI and BIS showed good consistency. At loss of consciousness, WLI and BIS had no significant differences. BIS had no significant difference during endotracheal intubation and incision and WLI showed significant differences during endotracheal intubation （P^0.05）. The Bland-Airman analysis showed that WI.I was accepted comparing with BIS during the period of anesthesia, the bias was --4.2 （95% limits of agreement： --24.7% to -- 11.7%）. Conclusion WLI is similar with BIS to monitor the depth of anesthesia during targetcontrolled infusion of propofol and remifentanyl.