熵指数监测在神经内镜垂体瘤手术全身麻醉深度监测中的应用

Application of entropy monitoring in the depth monitoring of general anesthesia in neuroendoscopic pituitary adenomas surgery

目的:观察熵指数(entropy)监测在神经内镜垂体瘤手术全身麻醉深度监测中的应用。方法:选取择期经鼻蝶神经内镜垂体瘤手术患者60例作为研究对象,随机分为对照组(C组)和熵指数监测组(E组)各30例。两组患者使用麻醉诱导和维持剂量后,对照组根据血流动力学指标(心率、血压)判断麻醉深度调节麻醉维持剂量。试验组为熵指数监测组,通过使反应熵(RE)和状态熵(SE)维持在40~60之间来调节麻醉维持剂量。观察记录两组患者麻醉药物使用剂量、围手术期血流动力学指标、呼吸恢复时间、拔管时间、拔管后镇静评分(Ramsay评分)、患者满意度及不良反应发生率等。结果:60例垂体瘤患者均安全、顺利经过神经内镜手术治疗。与C组比较,E组麻醉药物用量相对减少,且血流动力学指标更加稳定,差异有统计学意义(P<0.05);E组呼吸恢复时间、拔管时间短于C组,Ramsay评分明显低于C组,患者满意度高于C组,差异有统计学意义(P<0.05);C组不良反应发生率明显高于E组,其中以恶心为最多,均无术中知晓发生。结论:全身麻醉下行神经内镜垂体瘤手术时应用熵指数监测并调控麻醉深度,可有效减少麻醉药物的用量,缩短呼吸恢复时间、拔管时间,同时降低患者不良反应的发生率,有效提高麻醉质量。

Objective:To observe the application of entropy monitoring in the depth of general anesthesia in neuroendoscopic pituitary adenomas surgery.Methods:The 60 patients who underwent neuroendoscopic pituitary adenomas surgery were randomly divided into control group(C group)and entropy index monitoring group(E group).After the two groups used the induction and maintenance dose of anesthesia,the C group judged the depth of anesthesia to regulate the maintenance dose of anesthesia according to the hemodynamic index(heart rate,blood pressure).The E group was an entropy index monitoring group,which regulated the anesthetic maintenance dose by maintaining the response entropy(RE)and the state entropy(SE)between 40 and 60.Anesthetic dosage,perioperative hemodynamics,recovery time,extubation time,sedation score(Ramsay score),patients’satisfaction and incidence of adverse reactions were observed and recorded.Results:All the 60 patients with pituitary adenoma underwent neuroendoscopic surgery safely and smoothly.The dosage of anaesthetics in E group was relatively reduced compared with that in C group,and the hemodynamic indexes were better and stable.The difference was statistically significant(P<0.05).The recovery time and extubation time of E group were shorter than that of C group,and the Ramsay score was significantlylower than that of C group,and the patients’satisfaction was higher than that of the C group.The difference was statis-tically significant(P<0.05).The incidence of adverse reactions in C group was significantly higher than that in Egroup,with nausea being the highest,while no intraoperative knowledge occured.Conclusion:Using entropy to monitorand regulate the depth of anesthesia during neuroendoscopic pituitary adenomas surgery could effectively reduce the a-mount of anesthetics,shorten the recovery time and extubation time,besides reducing the incidence of adverse reac-tions and effectively improving the quality of anesthesia.