近似熵在脑电监测麻醉深度中的应用
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摘要
目的:探究脑电近似熵在麻醉深度监测中的应用。方法:以2017年1月～2018年1月择期行全麻手术的80例患者为研究对象,测定所有患者麻醉前、麻醉诱导5 min、术中60 min、麻醉苏醒时脑电双频指数(BIS)、脑电近似熵,且观察不同丙泊酚血浆浓度、改良镇静/警觉评分(MOAA/S)BIS值、脑电近似熵值的变化情况,Pearson相关性分析BIS、脑电近似熵值与丙泊酚血浆浓度的相关性。结果:麻醉诱导5 min、术中60 min BIS值、脑电近似熵值比麻醉前均显著降低(P<0.05),且术中60 min的值显著低于麻醉诱导5 min时的值(P<0.05);BIS值、脑电近似熵值随丙泊酚血浆浓度上升而下降,均呈显著负相关(P<0.05);脑电近似熵在MOAA/S评分0～1分变化中有显著差异(P<0.05),而BIS值无显著差异(P>0.05)。结论:脑电近似熵对丙泊酚药效变化评价效果与BIS相当,但其相对在麻醉镇静深度判断上有优势。
Objective To explore the application of electroencephalogram(EEG) approximate entropy in the monitoring of the depth of anesthesia. Methods Eighty patients who received elective surgery under general anesthesia from January 2017 to January2018 were enrolled in this study. The bispectral index(BIS) and EEG approximate entropy of all patients were measured before anesthesia, at 5 min after induction, at 60 min after the beginning of surgery and at recovery from anesthesia. With different plasma concentrations of propofol and modified observer's assessment of alertness/sedation scale(MOAA/S) scores, the changes of BIS value and EEG approximate entropy were analyzed. Finally, Pearson correlation analysis was performed to investigate the correlation of BIS and EEG approximate entropy with the plasma concentration of propofol. Results The BIS value and EEG approximate entropy at 5 min after induction and at 60 min after the beginning of surgery were significantly lower than those before anesthesia(P<0.05), and the values at 60 min after the beginning of surgery were significantly lower than those at 5 min after induction(P<0.05). The BIS value and EEG approximate entropy were negatively correlated with the plasma concentration of propofol(P<0.05). Moreover, statistical differences were found in the EEG approximate entropy when MOAA/S score was0-1(P<0.05), but there was no significant difference in BIS value(P>0.05). Conclusion Both EEG approximate entropy and BIS can effectively evaluate the therapeutic effects of propofol, but the former has more advantage in judging the depth of anaesthesia.
Objective To explore the application of electroencephalogram(EEG) approximate entropy in the monitoring of the depth of anesthesia. Methods Eighty patients who received elective surgery under general anesthesia from January 2017 to January2018 were enrolled in this study. The bispectral index(BIS) and EEG approximate entropy of all patients were measured before anesthesia, at 5 min after induction, at 60 min after the beginning of surgery and at recovery from anesthesia. With different plasma concentrations of propofol and modified observer's assessment of alertness/sedation scale(MOAA/S) scores, the changes of BIS value and EEG approximate entropy were analyzed. Finally, Pearson correlation analysis was performed to investigate the correlation of BIS and EEG approximate entropy with the plasma concentration of propofol. Results The BIS value and EEG approximate entropy at 5 min after induction and at 60 min after the beginning of surgery were significantly lower than those before anesthesia(P<0.05), and the values at 60 min after the beginning of surgery were significantly lower than those at 5 min after induction(P<0.05). The BIS value and EEG approximate entropy were negatively correlated with the plasma concentration of propofol(P<0.05). Moreover, statistical differences were found in the EEG approximate entropy when MOAA/S score was0-1(P<0.05), but there was no significant difference in BIS value(P>0.05). Conclusion Both EEG approximate entropy and BIS can effectively evaluate the therapeutic effects of propofol, but the former has more advantage in judging the depth of anaesthesia.
引文
[1]张文敬,房怿,申岱,等.麻醉深度监测与自主神经系统[J].国际麻醉学与复苏杂志,2017,38(11):1041-1044.ZHANG W J,FANG Y,SHEN D,et al.Anesthesia depth monitoring and autonomic nervous system[J].International Journal of Anesthesiology and Resuscitation,2017,38(11):1041-1044.
[2]邓佳,蒋璐,许婷,等.Narcotrend麻醉深度监测在全麻中的应用[J].四川医学,2016,37(2):167-170.DENG J,JIANG L,XU T,et al.Application of Narcotrend monitor to general anesthesia[J].Sichuan Medical Journal,2016,37(2):167-170.
[3]鹿曼曼,杨改生.麻醉深度监测对全身麻醉恢复时间影响的Meta分析[J].中国医药导报,2016,13(1):71-74.LU M M,YANG G S.Meta-analysis of effect of the anesthesia depth monitoring on anesthesia recovery time with general anesthesia[J].China Medical Herald,2016,13(1):71-74.
[4]辛永强.麻醉深度监测的进展研究[J].河北医药,2017,39(20):3158-3160.XIN Y Q.Progress in the monitoring of anesthesia depth[J].Hebei Medical Journal,2017,39(20):3158-3160.
[5]张列亮,华福洲,应俊,等.指光电容积脉搏波技术与脑状态指数用于麻醉深度监测的比较[J].实用医学杂志,2015,31(19):3178-3181.ZHANG L L,HUA F Z,YING J,et al.Comparison of finger photoplethysmogram and cerebral state index for monitoring depth of anaesthesia[J].The Journal of Practical Medicine,2015,31(19):3178-3181.
[6]刘岩,夏洪莲,薛剑锋,等.脑电熵指数及双频谱指数用于小儿七氟烷麻醉深度监测评价[J].中国药业,2017,26(14):17-19.LIU Y,XIA H L,XUE J F,et al.Evaluation of EEG entropy index and bispectral index in monitoring analgesic depth induced by sevoflurane anaesthesia[J].China Pharmaceuticals,2017,26(14):17-19.
[7]张少填,黄捷群,潘泽林,等.脑电近似熵在缺血性脑卒中起病24小时内特点分析[J].血栓与止血学,2017,23(3):385-388.ZHANG S T,HUANG J Q,PAN Z L,et al.Analysis of the characteristics of EEG approximate entropy of ischemic stroke within 24 hours of Onset[J].Chinese Journal of Thrombosis and Hemostasis,2017,23(3):385-388.
[8]刘红英,高庆春,张波,等.脑电非线性分析在尿毒症脑病诊断中的应用[J].广东医学,2017,38(8):1198-1199.LIU H Y,GAO Q C,ZHANG B,et al.Application of EEG nonlinear analysis in the diagnosis of uremic encephalopathy[J].Guangdong Medical Journal,2017,38(8):1198-1199.
[9]杨琨,曹建庭,王如彬,等.疑似脑死患者脑电信号的动态近似熵分析[J].中国生物医学工程学报,2011,30(1):27-33.YANG K,CAO J T,WANG R B,et al.Analyzing EEG of quasi-braindeath based on dynamic approximate entropy measures[J].Chinese Journal of Biomedical Engineering,2011,30(1):27-33.
[10]PINCUS S.Approximate entropy(Ap En)as a complexity measure[J].Chaos,1995,5(1):110-117.
[11]高春芳,张根葆,李田,等.基于样本熵的乌拉坦麻醉大鼠脑电特征初步研究[J].皖南医学院学报,2015,34(4):314-316.GAO C F,ZHANG G B,LI T,et al.Pilot study on EEG feature extraction of urethane-anesthetized rats based on sample entropy[J].Acta Academiae Medicinae Wannan,2015,34(4):314-316.
[12]程宏霞,王晓冬,邱颐,等.熵指数在麻醉深度监测中的临床应用[J].内蒙古医科大学学报,2015,37(2):211-214.CHENG H X,WANG X D,QIU Y,et al.The clinical application of entropy index in monitoring the depth of anesthesia[J].Journal of Inner Mongolia Medical University,2015,37(2):211-214.
[13]王冰舒.基于脑电的非线性参数近似熵对麻醉深度的监测及进展[J].实用医学杂志,2009,25(2):172-173.WANG B S.Monitoring and progress of anesthesia depth based on nonlinear parameter approximate entropy of EEG[J].The Journal of Practical Medicine,2009,25(2):172-173.
[14]李立,曹锐,相洁,等.脑电数据近似熵与样本熵特征对比研究[J].计算机工程与设计,2014,35(3):1021-1026.LI L,CAO R,XIANG J,et al.Comparative study of approximate entropy and sample entropy based on characterization of EEG[J].Computer Engineering and Design,2014,35(3):1021-1026.
[15]王胜军,郭云波,杨俊,等.复杂度、近似熵应用于麻醉深度监测中的实验研究[J].医疗卫生装备,2010,31(1):19-20.WANG S J,GUO Y B,YANG J,et al.Experiment research on complexity and ApEn in monitoring of anesthesia depth[J].Chinese Medical Equipment Journal,2010,31(1):19-20.
[16]徐进,郑崇勋,和卫星,等.基于脑电近似熵分析的麻醉深度监测研究[J].航天医学与医学工程,2004,17(3):205-209.XU J,ZHENG C X,HE W X,et al.Monitoring of anesthesia depth based on approximate entropy of EEG[J].Space Medicine&Medical Engineering,2004,17(3):205-209.
[17]周芳,申岱,刘家鹏,等.心率变异性近似熵分析法与脑电双频谱指数间的相关性[J].中国中西医结合外科杂志,2010,16(2):178-180.ZHOU F,SHEN D,LIU J P,et al.Correlation between monitoring parameters of approximate entropy of heart rate variability and BISduring general anesthesia[J].Chinese Journal of Surgery of Integrated Traditional and Western Medicine,2010,16(2):178-180.
[18]WEI Q,LIU Q,FAN S Z,et al.Analysis of EEG via multivariate empirical mode decomposition for depth of anesthesia based on sample entropy[J].Entropy,2013,15(9):3458-3470.
[19]FAN S Z,YEH J R,CHEN B C,et al.Comparison of EEGapproximate entropy and complexity measures of depth of anaesthesia during inhalational general anaesthesia[J].J Med Biol Eng,2011,31(5):359-366.
[20]BRUHN J,ROPCKE H,HOEFT A.Approximate entropy as an electroencephalographic measure of anesthetic drug effect during desflurane anesthesia[J].Anesthesiology,2000,92(3):715-726.
[2]邓佳,蒋璐,许婷,等.Narcotrend麻醉深度监测在全麻中的应用[J].四川医学,2016,37(2):167-170.DENG J,JIANG L,XU T,et al.Application of Narcotrend monitor to general anesthesia[J].Sichuan Medical Journal,2016,37(2):167-170.
[3]鹿曼曼,杨改生.麻醉深度监测对全身麻醉恢复时间影响的Meta分析[J].中国医药导报,2016,13(1):71-74.LU M M,YANG G S.Meta-analysis of effect of the anesthesia depth monitoring on anesthesia recovery time with general anesthesia[J].China Medical Herald,2016,13(1):71-74.
[4]辛永强.麻醉深度监测的进展研究[J].河北医药,2017,39(20):3158-3160.XIN Y Q.Progress in the monitoring of anesthesia depth[J].Hebei Medical Journal,2017,39(20):3158-3160.
[5]张列亮,华福洲,应俊,等.指光电容积脉搏波技术与脑状态指数用于麻醉深度监测的比较[J].实用医学杂志,2015,31(19):3178-3181.ZHANG L L,HUA F Z,YING J,et al.Comparison of finger photoplethysmogram and cerebral state index for monitoring depth of anaesthesia[J].The Journal of Practical Medicine,2015,31(19):3178-3181.
[6]刘岩,夏洪莲,薛剑锋,等.脑电熵指数及双频谱指数用于小儿七氟烷麻醉深度监测评价[J].中国药业,2017,26(14):17-19.LIU Y,XIA H L,XUE J F,et al.Evaluation of EEG entropy index and bispectral index in monitoring analgesic depth induced by sevoflurane anaesthesia[J].China Pharmaceuticals,2017,26(14):17-19.
[7]张少填,黄捷群,潘泽林,等.脑电近似熵在缺血性脑卒中起病24小时内特点分析[J].血栓与止血学,2017,23(3):385-388.ZHANG S T,HUANG J Q,PAN Z L,et al.Analysis of the characteristics of EEG approximate entropy of ischemic stroke within 24 hours of Onset[J].Chinese Journal of Thrombosis and Hemostasis,2017,23(3):385-388.
[8]刘红英,高庆春,张波,等.脑电非线性分析在尿毒症脑病诊断中的应用[J].广东医学,2017,38(8):1198-1199.LIU H Y,GAO Q C,ZHANG B,et al.Application of EEG nonlinear analysis in the diagnosis of uremic encephalopathy[J].Guangdong Medical Journal,2017,38(8):1198-1199.
[9]杨琨,曹建庭,王如彬,等.疑似脑死患者脑电信号的动态近似熵分析[J].中国生物医学工程学报,2011,30(1):27-33.YANG K,CAO J T,WANG R B,et al.Analyzing EEG of quasi-braindeath based on dynamic approximate entropy measures[J].Chinese Journal of Biomedical Engineering,2011,30(1):27-33.
[10]PINCUS S.Approximate entropy(Ap En)as a complexity measure[J].Chaos,1995,5(1):110-117.
[11]高春芳,张根葆,李田,等.基于样本熵的乌拉坦麻醉大鼠脑电特征初步研究[J].皖南医学院学报,2015,34(4):314-316.GAO C F,ZHANG G B,LI T,et al.Pilot study on EEG feature extraction of urethane-anesthetized rats based on sample entropy[J].Acta Academiae Medicinae Wannan,2015,34(4):314-316.
[12]程宏霞,王晓冬,邱颐,等.熵指数在麻醉深度监测中的临床应用[J].内蒙古医科大学学报,2015,37(2):211-214.CHENG H X,WANG X D,QIU Y,et al.The clinical application of entropy index in monitoring the depth of anesthesia[J].Journal of Inner Mongolia Medical University,2015,37(2):211-214.
[13]王冰舒.基于脑电的非线性参数近似熵对麻醉深度的监测及进展[J].实用医学杂志,2009,25(2):172-173.WANG B S.Monitoring and progress of anesthesia depth based on nonlinear parameter approximate entropy of EEG[J].The Journal of Practical Medicine,2009,25(2):172-173.
[14]李立,曹锐,相洁,等.脑电数据近似熵与样本熵特征对比研究[J].计算机工程与设计,2014,35(3):1021-1026.LI L,CAO R,XIANG J,et al.Comparative study of approximate entropy and sample entropy based on characterization of EEG[J].Computer Engineering and Design,2014,35(3):1021-1026.
[15]王胜军,郭云波,杨俊,等.复杂度、近似熵应用于麻醉深度监测中的实验研究[J].医疗卫生装备,2010,31(1):19-20.WANG S J,GUO Y B,YANG J,et al.Experiment research on complexity and ApEn in monitoring of anesthesia depth[J].Chinese Medical Equipment Journal,2010,31(1):19-20.
[16]徐进,郑崇勋,和卫星,等.基于脑电近似熵分析的麻醉深度监测研究[J].航天医学与医学工程,2004,17(3):205-209.XU J,ZHENG C X,HE W X,et al.Monitoring of anesthesia depth based on approximate entropy of EEG[J].Space Medicine&Medical Engineering,2004,17(3):205-209.
[17]周芳,申岱,刘家鹏,等.心率变异性近似熵分析法与脑电双频谱指数间的相关性[J].中国中西医结合外科杂志,2010,16(2):178-180.ZHOU F,SHEN D,LIU J P,et al.Correlation between monitoring parameters of approximate entropy of heart rate variability and BISduring general anesthesia[J].Chinese Journal of Surgery of Integrated Traditional and Western Medicine,2010,16(2):178-180.
[18]WEI Q,LIU Q,FAN S Z,et al.Analysis of EEG via multivariate empirical mode decomposition for depth of anesthesia based on sample entropy[J].Entropy,2013,15(9):3458-3470.
[19]FAN S Z,YEH J R,CHEN B C,et al.Comparison of EEGapproximate entropy and complexity measures of depth of anaesthesia during inhalational general anaesthesia[J].J Med Biol Eng,2011,31(5):359-366.
[20]BRUHN J,ROPCKE H,HOEFT A.Approximate entropy as an electroencephalographic measure of anesthetic drug effect during desflurane anesthesia[J].Anesthesiology,2000,92(3):715-726.