麻醉深度指数在靶控输注丙泊酚-雷米芬太尼麻醉诱导中的监测及评价

Monitoring and evaluating of cerebral state index in the induction of anesthesia with target- controlled infusion with propofol and remifentanil

目的评价麻醉深度指数（CSI）在靶控输注丙泊酚．雷米芬太尼麻醉诱导过程中预测患者麻醉深度的精确程度。方法全身麻醉下行择期手术患者44例，ASA分级Ⅰ～Ⅱ级，以效应室靶浓度4ng／ml靶控输注雷米芬太尼，输注10min时开始靶控输注丙泊酚，丙泊酚初始效应室靶浓度均为1．5μg／ml，每4min增加0．5μg／ml，改良警觉／镇静评分为1分时给予强直刺激，直至改良警觉／镇静评分为0分后1min停止试验。试验中监测患者CSI、平均动脉压（MAP）、心率、每20S行改良警觉，镇静评分、靶控输注系统预测效应部位浓度。结果CSI随改良警觉／镇静评分下降而下降，改良警觉，镇静评分5分时CSI为91±5，4分时为77±7，3分时为70±7，2分时为62±6，1分时为49±．12，0分时为364-10，两个相邻改良警觉，镇静评分比较差异均有统计学意义（P〈0．05）；MAP及心率在两个相邻改良警觉，镇静评分比较差异无统计学意义（P〉0．05）。CSI与改良警觉，镇静评分的Spearman等级相关系数、预测概率值均大于CSI与MAP，差异有统计学意义（P〈0．01或〈0．05）。CSI与丙泊酚靶控输注预测效应部位浓度存在线性回归关系（决定系数为0．812，P〈0．01）。结论在成年患者靶控输注丙泊酚．雷米芬太尼麻醉诱导状态下，CSI能够准确地区分清醒和麻醉后的不同意识水平，可靠地预测麻醉深度。

Objective To evaluate the accuracy of cerebral state index （CSI） as an indicator of anesthesia depth in the induction of anesthesia with target-controlled infusion （TCI） with pmpofol and remifentanil patients. Methods Forty-four ASA Ⅰ or Ⅱ patients undergoing elective surgery were anesthetized with TCI with propofol and remifentanil. Anesthesia was induced with TCI with remifentanil and propofol. The target effect-site concentration of remifentanil was 4 ng/ml. The initial effect-site concentration of propofol was 1.5μg/ml and was increased by 0.5 μ g/ml every 4 min, till 1 min after the level of observer＇s assessment of alertness sedation （OAA/S） score was 0 score. Electric tetanic stimulation was given when the level of OAA/S score was 1 score. The CSI, mean arterial pressure （MAP）, heart rate （HR）, OAA/S score and the effect-site concentration of propofol were recorded. Results CSI values declined with the decrease of OAA/S score, CSI was 91 ± 5,77± 7,70± 7,62 ± 6,49± 12,36 ±10 at OAA/S score with 5,4,3,2,1 score. CSI values were statistically different between 0 score and 1 score, 1 score and 2 scores, 3 scores and 4 scores,4 scores and 5 scores of OAA/S score（P 〈 0.05）. The differences of MAP,HR had no statistical significance between two scores of OAA/S score （P 〉 0.05）. The Spearman rank correlation coefficients between CSI, MAP, HR and OAA/S score were 0.899,0.342,0.125, respectively. The prediction probabilities to differentiate different OAA/S score for CSI, MAP, and HR were 0.89 ± 0.05, 0.62 ± 0.08, 0.53 ± 0.11, respectively. There was linear regression relationship between CSI and the effect-site concentration of propofol （the coefficient of determination was 0.812, P 〈 0.01 ）. Conclusion During the induction of patients with TCI with propofol and remifentanil, the CSI is accurate as an indicator of awakening and different levels of consciousness after anesthesia, and can reliably predict the anesthesia depth.