熵指数用于儿童唇裂手术七氟醚麻醉的可行性.docVIP

熵指数监测低龄儿童七氟醚麻醉深度的准确性 曹静 扈大为 张晓彤 石立新 (首都医科大学附属北京口腔医院麻醉科) [摘要]目的：探讨熵指数用于监测低龄患儿唇裂手术吸入七氟醚麻醉深度的准确性。方法：择期拟行唇裂修复手术的患儿45例，ASAⅠ级或Ⅱ级，年龄：0~36月，按年龄分为两组：Ⅰ组：12月，Ⅱ组：13~36月。所有患儿进入手术室后，用6%七氟醚，以6L/min氧流量（高流量）吸入诱导，气管插管，机械通气，氧流量调制3l/min，开始手术，调节七氟醚挥发罐刻度，使患儿呼吸末七氟醚浓度（CETSev）依次为1.5%，2.0%，2.5%，3.0%并保持每个CETSev达10min以上，同时记录患儿清醒时（T1）及不同CETSev（T2 –5）实时的心率（HR），平均压（MAP）,熵指数（状态熵SE、反应熵RE）。结果：两组比较T1-3时点熵指数Ⅰ组低于Ⅱ组（p0.05）；两组比较T4-5时点熵指数无统计学差异（p0.05）；与T1时刻比较Ⅰ组Ⅱ组T2 –5各时点 熵指数降低（p0.05）；随着CETSev的增大，熵指数降低，两者呈负相关，Ⅰ组和Ⅱ组CETSev与SE、RE的相关系数r分别为-0.682,-0.674，-0.701，-0.712，（p0.01）。结论： 低龄患儿七氟醚麻醉中使用用熵指数监测麻醉深度准确性较好。既使是年龄12月的婴幼儿也可使用。 关键词： 熵指数、儿童、麻醉、唇裂、监测、七氟醚 Accuracy of entropy for monitoring depth of sevoflurane anesthesia in young children Cao Jing,Hu Da Wei,Zhang Xiao Tong,Shi Li Xin.Department of anesthesiology,Beijing stomatological hospital,Beijing,100050,China. Abstract Objective: To evaluate the accuracy of entropy for monitoring depth of sevoflurane anesthesia in young children Methods: 45 children(0-36m) undergoing cheiloplasty surgery were divided into 2 groups.group Ⅰ 0-12m;group Ⅱ 13-36m.All of patients were anesthetized with sevoflurane.Anesthesia was induced with 6% evoflurane in 6L/min O2 .After tracheal intubation,the patients were mechanically ventilated.The end-tidal sevofourane concentration(CETSev) was maintained at 1.5%,2.0%,2.5%,3.0%.Each CETSev was maintained for at least 10 min, HR，MAP entropy（SE、RE）were monitored and recorded pre-awakening(T1) and at 1.5%,2.0%,2.5%,3.0% steady-seate CETSev(T2-5).Results: The entropy values were significantly higher in children of group Ⅱ than ingroup Ⅰat T1-3 .There was negative correlation between entropy(SE、RE) and CETSev in both groups(r=-0.682,-0.674，-0.701，-0.712).Conclusion :Entropy can accurately reflect the depth of sevoflurane anesthesia in young children even in infants(0-12m) Key words :Entropy Child Cheiloplasty Monitoring Sevofourane 熵指数是通过对脑电图（EEG）及前额肌电图（FEMG）的采集，然后运用特殊的运算方式将脑电信号的复杂程度用数字表达出来。信号变化或复杂程度越高，得到的熵指数值就越大。熵指数用于麻醉深度的监测有着良好的临床使用基础，使用熵指数监测可以