七氟醚与丙泊酚对慢性意识障碍患者全身麻醉期间脑电的影响

Effects of sevoflurane and propofol on electroencephalography during general anesthesia in patients with prolonged disorders of consciousness

目的:探讨七氟醚吸入麻醉与丙泊酚静脉麻醉对慢性意识障碍(pDoC)患者围术期脑电的影响。方法:前瞻性纳入解放军总医院第七医学中心神经外科和首都医科大学附属天坛医院神经外科自2022年1月至8月拟行短程脊髓电刺激术(st-SCS)的20例pDoC患者,按照随机数字表法分为七氟醚组(10例)和丙泊酚组(10例)。采用19通道脑电设备记录2组患者麻醉前、麻醉中、麻醉后3个时间段全脑的脑电活动变化。结果:2组患者麻醉中的脑电功率谱均以δ功率增加,θ、β、γ功率减少为特征。麻醉后,七氟醚组较丙泊酚组有更多的快波活动(θ+α+β)和更少的慢波活动(δ)。脑电指标区分清醒和麻醉状态的ROC曲线显示,以额叶区域的置换熵(PE)和置换Lempel-Ziv复杂度(PLZC)指标区分度最好,丙泊酚额叶PE(AUC:0.865)大于七氟醚额叶PE(AUC:0.815),丙泊酚额叶PLCZ(AUC:0.865)大于七氟醚(AUC:0.810)。结论:七氟醚与丙泊酚对pDoC患者麻醉状态的脑电活动影响是类似的,但七氟醚组比丙泊酚组具有更好的苏醒后表现。脑电监测对评估全麻期间意识状态有重要意义,快慢波功率比值、PE、PLZC等作为表征麻醉深度的脑电指标在pDoC患者中表现出较强的适用性,额叶区域的PE和PLZC区分清醒和麻醉的能力最强。

Objective To investigate the effects of sevoflurane inhalation anesthesia and propofol intravenous anesthesia on electroencephalogram(EEG)in patients with prolonged disorders of consciousness(pDoC)during perioperative period.Methods Twenty patients with pDoC who planned to undergo short-range electrical stimulation of the spinal cord(st-SCS)in Neurosurgery Department of The Seventh Medical Center of PLA General Hospital,and the Neurosurgery Department of Beijing Tiantan Hospital,Capital Medical University from January to August 2022,were prospectively included,and divided into sevoflurane group(10 cases)and propofol group(10 cases)according to the random number table.The 19-channel EEG equipment was used to record the changes of brain electrical activity before,during and after anesthesia in both groups.Results The EEG power spectra during anesthesia in both groups were characterized by an increase inδpower and a decrease inθ,βandγpower.After anesthesia,sevoflurane group had more fast wave activity(θ+α+β)and less slow wave activity(δ)than propofol group.The area under the ROC curve of EEG indicators which distinguish awake and anesthesia states showed that permutation entropy(PE)and permutation Lempel-Ziv complexity(PLZC)in the frontal lobe region were the best indicators of discrimination,propofol frontal lobe PE(AUC:0.865)>sevoflurane frontal lobe PE(AUC:0.815),propofol frontal lobe PLCZ(AUC:0.865)>sevoflurane(AUC:0.810).Conclusion Sevoflurane and propofol have similar effects on brain electrical activity in pDoC patients under anesthesia,but sevoflurane group has better performance than propofol group after awakening.EEG monitoring is of great significance to evaluate the state of consciousness during general anesthesia.The ratio of fast and slow wave power,PE and PLZC as EEG indicators to describe the depth of anesthesia shows strong applicability in patients with prolonged disorders of consciousness.The PE and PLZC of frontal lobe can distinguish awake from anesthesia best.