甲状旁腺自体移植术患者右美托咪定镇静的熵指数变化

Change characteristics of entropy in monitoring sedation depth of dexmedetomidine in patients before parathyroid autologous transplantation

目的：评价熵指数在监测右美托咪定用于慢性肾衰继发甲旁亢行甲状旁腺自体移植术患者全麻诱导前镇静深度的变化特点。方法：试验组（E组）为择期行甲状旁腺全切除术的慢性肾衰患者20例,ASAⅡ~Ⅲ级,年龄18~65周岁,体质量指数18~25 kg/m2;对照组（C组）为择期行甲状腺腺瘤切除术的一般患者20例,ASAⅠ~Ⅱ级且无系统性疾病。两组在麻醉诱导前均输注负荷剂量0.9 m L·kg^-1·h^-1的右美托咪定10 min（右美托咪定浓度为4μg/m L）,然后开始麻醉诱导。分别于输注前（T0）、输注1 min（T1）、5 min（T2）、7 min（T3）、11 min（T4）时记录反应熵（RE）、状态熵（SE）并计算RE-SE的值。结果：与T0相比,E组在T4时的RE和SE均下降（P〈0.05）;与C组相比,E组在T4时的RE和SE较低（P〈0.05）,且E组的RE-SE在T3时同样低于C组。结论：在右美托咪定用于全麻诱导前镇静时,甲状旁腺自体移植术患者的熵指数较一般患者明显降低。

AIM： To evaluate the change characteristics of entropy in monitoring sedation depth of dexmedetomidine when applied in pre-anesthesia induction of patients with chronic renal failure and secondary hyperparathyroidism that were planning to do parathyroidectomy and autotransplantation.METHODS： Twenty ASA physical status Ⅱ-Ⅲ patients with chronic renal failure,aged 18-65 yr,with BMI of 18-25 kg / m2,scheduled for parathyroidectomy were included into Group E,and twenty ASA physical status Ⅰ-Ⅱ patients with no systemic disease were included into Group C. Dexmedetomidine injection（ drug concentration was 4 μg / m L） 0. 9 m L·kg^-1·h^-1was infused intravenously in both groups for 10 minutes before anesthesia induction. Recorded the value of RE and SE before infusion（ T0）,and 1 min（ T1）,5min（ T2）,7 min（ T3）,11 min（ T4） since the infusion started,then calculated Dvalue of RE-SE. RESULTS： Compared with T0,both of RE and SE in Group E was significantly decreased at T4（ P〈0. 05）; RE and SE in Group E was significantly lower than that of Group C at T4（ P〈0. 05）,likewise RE-SE at T3. CONCLUSION：Compared with normal patients,entropy was significantly lower in monitoring sedation depth of dexmedetomidine when applied in pre-anesthesia induction of patients with chronic renal failure and secondary hyperparathyroidism.