熵指数在妇科手术静吸复合麻醉中的应用

Application of entropy monitoring during general anaesthesia of gynaecological surgery

目的观察熵指数在静吸复合麻醉中对于意识水平变化监测的应用价值。方法 50例ASAⅠ～Ⅱ级妇科患者静吸复合麻醉下30例行子宫切除术,20例行附件肿物切除术。麻醉诱导:咪唑安定2 mg,丙泊酚2 mg/kg,舒芬太尼0.5μg/kg,罗库溴胺0.6 mg/kg;麻醉维持:丙泊酚6 mg/(kg·h),维持异氟醚1.5MAC吸入,间断静脉注射顺苯阿曲库胺,麻醉全过程监测熵指数,根据熵指数数据变化追加舒芬太尼。观察基础值、意识消失时、插管即刻、插管后3 min、意识恢复即刻、意识恢复后3 min的熵指数(Entropy):反应熵RE(Response entropy)和状态熵SE(State entropy)。结果诱导后RE、SE、RE-SE同时下降(P<0.01);术毕意识恢复前逐渐升高,在意识恢复即刻之后逐渐接近基础值,RE变化较明显。结论熵指数尤其是反应熵对于监测全麻期间意识水平及麻醉深度敏感、有效,从而指导麻醉用药,所以熵指数的应用有非常好的临床价值。

Objective To observe the entropy index in balanced anesthesia for consciousness level change monitoring application value. Methods All 50 cases of ASA I - II gynecologic patients under inhalational combined with intravenous anesthesia in 30 cases of hysterectomy, 20 routine adnexal tumor resection. Induction of anesthesia：2 mg midazolam, propofol 2 mg/kg, sufentanil 0.5μg/kg, Rocuronium 0.6 mg/kg. Anesthesia was maintained with propofol 6 mg/（kg ·h）, maintaining isoflurane inhalation 1.5 MAC, intermittent intravenous injection of Cisatracurium Besilete. anesthesia monitoring based on the whole process of entropy, entropy index data change adding sufentanil. Observation value, beline , loss of consciousness, intubation, immediately after intubation for 3 minutes, and recovery of consciousness, immediately regaining consciousness after 3 minutes of entropy index. Results After the induction of RE, SE, RE-SE drop at the same time （P 〈 0.01）; postoperative recovery of consciousness before gradually increased, in the sense of recovered instantly after gradually closer to the base value. Conclusion Entropy index monitoring during general anesthesia awareness level sensitive, effective, so it has certain application value.