熵指数和脑电双频谱指数在判断意识上的比较

Comparative investigation of the entropy and bispectral index in monitoring the consciousness

目的比较熵指数在预测意识消失的趋势方面、肌电活动的影响方面和反映伤害性刺激方面与脑电双频谱指数(BIS)监测的差异。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。麻醉诱导异丙酚的靶控血浆浓度均从4μg/ml开始,每30s进行一次警觉/镇静评分(OAA/S评分),直至患者意识消失(OAA/S评分≤1分),记录每次OAA/S评分即刻的熵指数(RE、SE)和BIS值。麻醉维持靶控输注异丙酚和瑞芬太尼,缝皮时停止输注。记录患者意识消失前后和意识恢复前后每30s的熵指数和BIS值。结果熵指数和BIS在意识消失前30s与意识消失即刻比较显著降低(SE78.1至67.3,RE85.9至72.7,BIS80.7至66.0,P均<0.01)。但是在意识恢复前30s与意识恢复即刻比较,BIS虽然升高,但差异无统计学意义(66.6至71.6),而SE(65.3至75.4)和RE(73.4至89.2)的增高十分显著(P<0.05,P<0.01)。SE、RE、BIS与OAA/S在诱导阶段相关系数(r)分别0.813、0.875、0.749(P<0.01)。SE、RE、BIS镇静深度Pk值分别为0.83±0.07、0.89±0.05、0.81±0.04。结论熵指数与BIS在监测镇静深度和判断意识消失方面均能达到较好效果。但是在异丙酚麻醉恢复期的意识判断上熵指数(SE,RE)可能优于BIS。

Objective To study the advantages of entropy monitoring in the depth of anesthesia in clinic and com-pare it with the BIS to clarify whether NT has more advantages on predicting the trend of loss of consciousness（LOC）, over-coming the influence of electromyogram （EMG） on electroencephalogram （EEG）, and reflecting noxious painful stimulus. Methods Thirty ASA Ⅰ-Ⅱ patients scheduled for laparoscopic cholecystectomy or laparoscopic gynecological operation were enrolled in this study. Anesthesia was induced with TCI propofol （effect-site concentration was set at 4 μg/ml）, and rocuronium. Then it was maintained with TCI propofol and remifentanyl and intermittent rocuronium intravenous boluses. Entropy and the BIS were continuously monitored during operation. Results The entropy index （RE, SE） and BIS were both significantly decreased 30 s before the LOC when compared with LOC （SE 78.1 to 67.3, RE 85.9 to 72.7, BIS 80.7 to 66.0, P 〈 0.01）. However, when 30 s before the recovery of the consciousness （ROC） was compared with the ROC, the En-tropy was significantly different （SE 65.3 to 75.4, RE 73.4 to 89.2, P 〈 0.05, P 〈 0.01） from IBS （66.6 to 71.6）. The corre-lation coefficient of SE, RE and BIS with OAA/S was 0.813,0.875 and 0.749 respectively（P 〈 0.01 ）. Pk values for SE, RE and BIS were 0.826±0.073,0.892±0.048 and 0.809±0.044 respectively. Conclusion Both entropy and BIS are good in monitoring the depth of the sedation and judging the LOC. But he entropy may be better than BIS in determine the con-sciousness status during the recovery of the anesthesia with propofol.