摘要
目的 评价熵指数（RE/SE）监测异丙酚＋瑞芬太尼静脉全身麻醉患者伤害性刺激强度的可行性.方法 选择18～65岁择期行下腹部手术、美国麻醉协会（ASA）分级为Ⅰ～Ⅱ级的全身麻醉患者60例,根据麻醉诱导时瑞芬太尼的不同输注浓度随机分为两组：瑞芬太尼浓度在气管插管前由0 ng/ml变为1 ng/ml（A组）和瑞芬太尼浓度始终维持在3 ng/ml（B组）.在指定时间先后给予80 mA强直电刺激（T2）、气管插管刺激（T12）及切皮刺激（T12＇）.分别比较反应熵（RE）和状态熵（SE）在3种不同程度刺激前后的变化.结果 12例患者因使用血管活性药物而退出本研究,A组实验对象为28例,B组实验对象20例.强直电刺激前后,RE和SE在两组内均无明显变化（P均＞0.05）;气管插管后,B组RE和SE较插管前明显升高（P均＜0.05）,A组无明显变化（P均＞0.05）;切皮刺激后,两组RE和SE较切皮前均明显升高（P均＜0.05）.同一刺激条件下,RE和SE在不同瑞芬太尼药物浓度组间差异无统计学意义（P均＞0.05）.结论 在异丙酚＋瑞芬太尼麻醉下,伤害性刺激可导致RE和SE不同程度的增高,RE/SE可作为全身麻醉患者伤害性刺激强度的反映指标.
Objective To evaluate the efficacy of reflex entropy （RE） /state entropy （SE） in moni- toring the response to noeiceptive stimulus during propofol-remifentanil infusion. Methods After the approval of the hospital ethics committee, sixty American Society of Anesthesiologists （ASA） classification Ⅰ - Ⅱ patients, aged 18-65 years, receiving the hypogastrium operation undergoing general anesthesia, were randomly allocated to groups A and B with different remifentanil concentrations. After the concentration of propofol and remifentanil reached balance, tetanic stimulation, intubation, and incision were performed respectively with certain inter- vals. RE and SE were monitored during this procedure. Results Twelve patients were withdrawn from this study due to the use of vasoactive drugs. Finally, there were 28 cases in group A and 20 cases in group B. The RE and SE were not significantly changed before and after the tetanic stimulation in both groups （ all P 〉 0. 05 ）. Both RE and SE were significantly increased after intubation in group B （ both P 〈 0. 05 ） and after skin incision in both groups （ all P 〈 0. 05 ）. Under the same stimulation, RE and SE showed no significant difference among groups administered with different levels of remifentanil （ P 〉 0.05 ）. Conclusion Under the anesthesia with propofol ＋ remifentanil, nociceptive response may cause the increase of RE and SE. Therefore, RE and SE may be useful parameters for monitoring the nociceptive response during general anaesthesia.
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2014年第1期68-72,共5页
Acta Academiae Medicinae Sinicae
关键词
伤害性刺激
熵指数
全身麻醉
刺激强度
nociceptive stimulus
entropy
general anesthesia
stimulus intensity
