麻醉设备学：第十章 麻醉深度监测仪器.pptVIP

课后思考题 1、论述脑电双频谱分析的临床应用 2、名词：诱发电位 3、AEP与BIS相比的优缺点。 4、论述听觉诱发电位的临床应用。 * Each practitioner may approach these components through a variety of different drug concentrations and practices. There are numerous means involved in providing comfort, and it is helpful to think of them in terms of three main components - hypnosis (lack of consciousness), analgesia (lack of autonomic and somatic responses), and areflexia or muscle relaxation (lack of involuntary movement). ? Monitoring each of these components requires separate measurements. There are well accepted methods to monitor the latter two components (analgesia and muscle relaxation). Until recently, it has been challenging to accurately measure the first: the state of consciousness. * USE THIS SLIDE FOR BIS A-2000 OR FOR BIS WITH PATIENT MONITORING SYSTEMS OTHER THAN GE OR PHILIPS (Hide the Philips and GE slides) As you can see, the BIS technology is available as a stand-alone monitor or in modular format integrated into leading patient monitoring systems. To monitor a patient, you will need a monitor or a module and a sensor. The sensor, placed on the patient’s forehead, detects the electrical activity of the brain, or EEG. ? The characteristic changes in the EEG are evaluated by the monitor’s sophisticated algorithm, and an objective measure of the sedative drug effect is displayed as the BIS value. 第二节 脑电双频谱分析 一、脑电双频谱分析原理 脑电双频谱分析是在功率谱分析基础上，通过对脑电相干函数谱的分析，对EEG信号的频率、功率、相位和谐波进行综合处理，通过分析各频率中高阶谐波的相互关系，进行EEG信号频率间相位藕合的定量测量。 脑电双频谱分析 双频谱的综合特性（频率、功率、相位、谐波）指标可以反映更细微的脑电变化信息。 双频谱指数 为了能够较为方便地应用于临床，引入双频谱指数（bispectral index, BIS)的表达形式。BIS是一个多变量的综合指标，它是对不同的麻醉中一系列EEG的不同特征进行分析所得到的双频谱变量。 脑电双频谱分析的应用 BIS是现有监测中灵敏度和特异度较佳的参数。脑电双频谱指数由小到大，表达相应的镇静水平和清醒程度。脑电双频谱指数等于0，表示脑电等电位；脑电双频谱指数等于100，表示完全清醒状态。可以根据脑电双频谱指数的大小及其变化监测麻醉深度。 BIS与麻醉深度 BIS值 麻醉深度 100 完全清醒 ＞95 清醒 ＜70 睡眠 40～60 常用临床麻醉深度 0 脑电等电位 BIS监测镇静水平 BIS能很好地监测麻醉深度中的镇静水平，但对镇痛水平的监测不敏感。BIS的麻醉阈值受多种麻醉药联合应用的影响是其最显著的局限性。换言之，不同组合的麻醉药联合应用时虽得到相似的BIS值，但可能代表着不同的麻醉深度。 B