脑电非线性监测的临床研究
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摘要
第一部分:脑电非线性分析监测在异丙酚靶控输注中的应用
目的:采用脑电非线性分析监测技术,研究异丙酚靶控输注对不同脑区的作用,并探讨其临床意义。
方法:选择40例择期行腹部手术的患者,随机分为异丙酚3ug/ml靶控输注组(A组)、异丙酚4ug/ml靶控输注组(B组),每组20例,麻醉方法采用全凭静脉异丙酚靶控输注麻醉。监测患者清醒时、诱导、术中、苏醒、出室时的不同脑区的脑电非线性参数—近似熵(ApEn)、关联维数(D2)和复杂度(Cx),观察经非线性分析实时处理的脑电非线性地形图的变化,以及BP、HR、SpO_2变化。
结果:异丙酚镇静下患者各个脑区的非线性参数值均显著下降(P＜0.05);组内患者,术中与清醒时、苏醒相比较,近似熵(ApEn)、关联维数(D2)和复杂度(Cx)下降有显著差异(P＜0.05);A组与B组之间,同一阶段近似熵(ApEn)、关联维数(D2)和复杂度(Cx)下降幅度无显著差异(P＞＞0.05),诱导时从额叶和顶叶区向颞叶和枕叶区抑制,苏醒时又从颞叶和枕叶区向额叶和顶叶区恢复。
结论:异丙酚靶控麻醉下,异丙酚对各个脑区的抑制程度不同。靶控输注异丙酚3ug/ml与异丙酚4ug/ml,对脑区的抑制在非线性监测下没有显著差异。
第二部分:全麻状态下呼末二氧化碳对脑电非线性参数的影响
目的:采用脑电非线性分析监测技术,研究全麻状态下不同呼末二氧化碳对脑电非线性参数变化的影响,探讨其临床意义。
方法:随机选择15例择期行腹部或下肢手术的患者,ASAⅠ～Ⅱ级,麻醉方法采用全凭静脉异丙酚靶控镇静(3ug/ml),每例患者在术中分别将呼末二氧化碳分压调至(25±2)mmHg-A组,(35±2)mmHg-B组,(45±2)mmHg-C组,每组维持15分钟。监测记录患者在不同呼末二氧化碳分压时段的脑电非线性参数—近似熵(ApEn)、关联维数(D2)和复杂度(Cx),常规监测BP,HR,spO2,PetCO2。
结果:在不同呼末二氧化碳分压的条件下,额部的脑电非线性参数—近似熵(ApEn)和关联维数(D2)的变化均存在显著差异(p＜0.05),而复杂度(Cx)未出现统计学差异。
结论:术中PetCO2的变化直接影响原始脑电活动,这种变化对麻醉深度的影响通过非线性脑电监测仪得到认证,PetCO2间接影响麻醉深度。
Part I: The application of EEG non-linear analysisunder anaesthesia of propofol with target-concentration
Objective To study the brain distribution of propofol sedation with target- concentration anesthesia. Methods 40 patients undergoing expected abdomen and limb operations were randomly divided into Propofol 3ug/ml group (A) and 4ug/ml group (B), each group had 20 cases. The combined intravenous anesthesia used propofol with target-concentration. The perioperative EEG non-linear parameter and perioperative EEG non-linear topographic Map of Approximate Entropy were recorded. BP, HR, SpO2 were recorded as usually Results The non-linear parameters were decreased at all brain areas with the propofol sedation. Comparing to pre-operation No significant differences were found between the two groups. Under combined intravenous propofol of target-concentration anaesthesia, the brain area restrain sequence of propofol were from frontal area and parietal area to temporal area and occipital area. The clearance sequence of propofol were from occipital area and temporal area to frontal area and parietal area. Conclusion Under intravenous combined propofol anaesthesia,the brain areas restrain of propofol was different. At inducement, the restrain began from frontal area and parietal area to temporal and occipital area. At anabiosis, the excitation began from occipital area and temporal area to frontal area and parietal area. Within propofol 3ug/ml group and propofol 4ug/ml group , under EEG no-liner analysis, the brain areas restrain of propofol wasn't different notably.
Part II: The influmence of changes of carbon dioxidepressure of end-tidal on the EEG no-linear parametersduring the anesthesia
Objective: To study the influmence of changes of carbon dioxide pressure at the end of expiration on the no-linear parameters during the anesthesia. Methods: to choose randomly 15 patients undergoing expected abdomen and limb operations . The combined intravenous anesthesia used propofol with target-concentration. The carbon dioxide pressure of end-tidal of every patient was adjusted to three levels, (25±2)mmHg, (35±2)mmHg and(45±2)mmHg, every level lasted fifteen minutes. The EEG non-linear parameters of Approximate entropy; Correlation Dimension; Complexity were recorded at the every level. BP, HR, SpO2 and PetCO2 were recorded as usually. Results: The cardon dioxide pressure of end-tidal was different significantly, the EEG non-linear parameters of ApEn、D2 changed significantly , but the change of Cx was little. Conclusion: The variation of PetCO2 during the operation between the 25-45 mmHg produce significant changes in qEEG, result in the degree of anaesthsia make significant change in the EEG non-linear parameters.
目的:采用脑电非线性分析监测技术,研究异丙酚靶控输注对不同脑区的作用,并探讨其临床意义。
方法:选择40例择期行腹部手术的患者,随机分为异丙酚3ug/ml靶控输注组(A组)、异丙酚4ug/ml靶控输注组(B组),每组20例,麻醉方法采用全凭静脉异丙酚靶控输注麻醉。监测患者清醒时、诱导、术中、苏醒、出室时的不同脑区的脑电非线性参数—近似熵(ApEn)、关联维数(D2)和复杂度(Cx),观察经非线性分析实时处理的脑电非线性地形图的变化,以及BP、HR、SpO_2变化。
结果:异丙酚镇静下患者各个脑区的非线性参数值均显著下降(P＜0.05);组内患者,术中与清醒时、苏醒相比较,近似熵(ApEn)、关联维数(D2)和复杂度(Cx)下降有显著差异(P＜0.05);A组与B组之间,同一阶段近似熵(ApEn)、关联维数(D2)和复杂度(Cx)下降幅度无显著差异(P＞＞0.05),诱导时从额叶和顶叶区向颞叶和枕叶区抑制,苏醒时又从颞叶和枕叶区向额叶和顶叶区恢复。
结论:异丙酚靶控麻醉下,异丙酚对各个脑区的抑制程度不同。靶控输注异丙酚3ug/ml与异丙酚4ug/ml,对脑区的抑制在非线性监测下没有显著差异。
第二部分:全麻状态下呼末二氧化碳对脑电非线性参数的影响
目的:采用脑电非线性分析监测技术,研究全麻状态下不同呼末二氧化碳对脑电非线性参数变化的影响,探讨其临床意义。
方法:随机选择15例择期行腹部或下肢手术的患者,ASAⅠ～Ⅱ级,麻醉方法采用全凭静脉异丙酚靶控镇静(3ug/ml),每例患者在术中分别将呼末二氧化碳分压调至(25±2)mmHg-A组,(35±2)mmHg-B组,(45±2)mmHg-C组,每组维持15分钟。监测记录患者在不同呼末二氧化碳分压时段的脑电非线性参数—近似熵(ApEn)、关联维数(D2)和复杂度(Cx),常规监测BP,HR,spO2,PetCO2。
结果:在不同呼末二氧化碳分压的条件下,额部的脑电非线性参数—近似熵(ApEn)和关联维数(D2)的变化均存在显著差异(p＜0.05),而复杂度(Cx)未出现统计学差异。
结论:术中PetCO2的变化直接影响原始脑电活动,这种变化对麻醉深度的影响通过非线性脑电监测仪得到认证,PetCO2间接影响麻醉深度。
Part I: The application of EEG non-linear analysisunder anaesthesia of propofol with target-concentration
Objective To study the brain distribution of propofol sedation with target- concentration anesthesia. Methods 40 patients undergoing expected abdomen and limb operations were randomly divided into Propofol 3ug/ml group (A) and 4ug/ml group (B), each group had 20 cases. The combined intravenous anesthesia used propofol with target-concentration. The perioperative EEG non-linear parameter and perioperative EEG non-linear topographic Map of Approximate Entropy were recorded. BP, HR, SpO2 were recorded as usually Results The non-linear parameters were decreased at all brain areas with the propofol sedation. Comparing to pre-operation No significant differences were found between the two groups. Under combined intravenous propofol of target-concentration anaesthesia, the brain area restrain sequence of propofol were from frontal area and parietal area to temporal area and occipital area. The clearance sequence of propofol were from occipital area and temporal area to frontal area and parietal area. Conclusion Under intravenous combined propofol anaesthesia,the brain areas restrain of propofol was different. At inducement, the restrain began from frontal area and parietal area to temporal and occipital area. At anabiosis, the excitation began from occipital area and temporal area to frontal area and parietal area. Within propofol 3ug/ml group and propofol 4ug/ml group , under EEG no-liner analysis, the brain areas restrain of propofol wasn't different notably.
Part II: The influmence of changes of carbon dioxidepressure of end-tidal on the EEG no-linear parametersduring the anesthesia
Objective: To study the influmence of changes of carbon dioxide pressure at the end of expiration on the no-linear parameters during the anesthesia. Methods: to choose randomly 15 patients undergoing expected abdomen and limb operations . The combined intravenous anesthesia used propofol with target-concentration. The carbon dioxide pressure of end-tidal of every patient was adjusted to three levels, (25±2)mmHg, (35±2)mmHg and(45±2)mmHg, every level lasted fifteen minutes. The EEG non-linear parameters of Approximate entropy; Correlation Dimension; Complexity were recorded at the every level. BP, HR, SpO2 and PetCO2 were recorded as usually. Results: The cardon dioxide pressure of end-tidal was different significantly, the EEG non-linear parameters of ApEn、D2 changed significantly , but the change of Cx was little. Conclusion: The variation of PetCO2 during the operation between the 25-45 mmHg produce significant changes in qEEG, result in the degree of anaesthsia make significant change in the EEG non-linear parameters.
引文
[1]吴东宇,董为伟.脑电非线性分析在认知功能研究中的应用.中华神经科杂志,2003,36(5):335
[2]吴东宇,贾宝森,尹岭.脑电非线性分析在麻醉深度监测中的应用.解放军医学杂志,2005,30(1):40
[3]张宏,贾宝森,米卫东等.静吸复合麻醉下吸入麻醉药物脑区分布和记忆变化的脑电非线性分析研究.解放军医学杂志,2005,30(1):29
[4]贾宝森,张宏,米卫东等.静脉复合麻醉下异丙酚脑区分布和记忆变化的脑电非线性分析研究.解放军医学杂志,2005,30(1):33
[5].Pritchard WS,Duke DW.Measuring "Chaos" in the Brain:A Tutorial Review of EEG Dimension Estimation.Brain and Cognitive.1995;27:353-397
[6]Jelles B,van-Birgelen.JH,Slaets JP,et al.Decrease of non-linear structure in the EEG of Alzheimer patients compared to healthy restrains.Clin-Neurophysiol.1999 Jul;110(7):1159-67.
[7]Zhang XS,Roy RJ,Jensen EW.EEG complexity as a measure of depth of anesthesia for patients.IEEE-trans-biomed-Eng.2001 Dec;48(12):1424-1433
[8]Russell IF,Wang M.Absence of memory for intraoperative information during surgery with total intravenous anesthesia.Br J Anesth 2001; 86:196-202.
[9] Kalkman CJ,Boezeman EH,Ribberink AA,et al. Influence of changes in arterial carbon dioxide tension on the electroencephalogram and posterior tibial nerve somatosensory cortical evoked potentials during alfentanil/nitrousoxideanesthesia Anesthesiology 1991,75 :68-74
[10] Kennealy JA, Penovich PE,Moor Nease SE. EEG and spectral analysis in acute hyperventilation. Electroenceph Clin Neurophsiol.6,63:98 106
[11] Xu Nan,Xu Jinghua.The fractal dimension of EEG as a Physical measure of conscious humanbrain activities. Bulletin of Mathematical Biology. 1988,50:559-565.
[12] Bullmore,E.T.,et al.Fractal analysis of electroenc-ephalographic signals intra- cerebrally recorded during 35 epileptic seizures :evaluation of a new method for synoptic visualization of ictal events. Electroenceph. clin.Neurophysiol.1994,91: 337-345.
[13] Roschke,J.,Aldenholf,J. The dimensionality of human's electro-encephalogram during sleep. Biol.Cybern. 1991,64:307-313.
[14] Pritchard,W.S.,etal.EEG-based,neural-net predictive classification of Alzheimer' s diseaseversus control subjects is augmented by non-linear EEG measures.Electroenceph.clin. Neurophysiol.1994,91:118-130.
[15]张宏,贾宝森,米卫东等.静吸复合麻醉下吸入麻醉药物脑区分布和记忆变化的脑电非线性分析研究.解放军医学杂志,2005,30(1):29
[16]韩如泉,王保国,王恩真.不同动脉血二氧化碳分压对数量化脑电图的影响,2000,20:471
[17]韩文斌.M A C的临床研究进展。国外医学麻醉学与复苏分册,1996,17:303
[18]Patel VM,Manlsby RL.How hyperventilation alters the electroencephalogram:a review of controversial viewpoints emphasizing neurophysiological mechanisms.J Clin Neurophysial.1987,4:101-120
[19]欧阳铭文,吴东宇,张宏.异丙酚靶控输注镇静时脑电双频指数和非线性参数变化分析.解放军医学杂志.2006,6.31(6):597-598.
[20]贾宝森.围术期脑电监测系统研究的新进展.军医进修学院博士论文.2005:80-92.
[1]. Lopes-da-Silva FH . Neural Mechanism underlying Brain Wave: from branches to network. Electro-clin-Neurophysiol.1991,79:81-93.
[2]. Pritchard WS, Duke DW. Measuring "Chaos" in the Brain: A Tutorial Review of EEG Dimension Estimation. Brain and Cognitive. 1995,27:353-397.
[3]. Jelles B, van-Birgelen JH, Slaets JP,etal. Decrease of non-linear structure in the EEG of Alzheimer patients compared to healthr controls. Clin-Neurophysiol.1999,16:822-835.
[4]. Jorgen B,Heiko,Ropcke,etal.Approximate entropy as an elect roce nceph-alographic measure of anesthetic drug effect during desflurane anesthesia. Anesthesiology,2000,92:715-726.
[5]. Approximate entropy as an measure of system complexity.Proc Natl Acad Sci USA, 1991,88:2297-2301.
[6]. Roelfsema F,Pincus S M,Veldhuis JD.Patients with cushing'disease secrete adrenocorticotropin and cortisol jointly more asynchronously than healthy subjects.J Clin Endocrinol Metab,1998,83:688-692.
[7]. Makikallio TH,Ristimate T,Airaksinen KE,etal.Heart rate dynamics in patients with stable angina pectoris and utility of fractal and complexity measures. Am J CArdiol, 1998,81:27-31.
[8]. Anthony GH.Effect of volatile anesthetics on interhemispheric EEG cross approximate entropy in the rat.Brain Research,2002,954:123-137.
[9].吴东宇,董为伟.非线性动力学分析在脑电图中的应用.临床神经电生理学杂志.2003.3,12(1):46-51.
[10].吴东宇,董为伟。脑电非线性分析在认知功能研究中的应用.中华神经科杂志.2003.11,36(5):335-338.
[11].吴东宇.脑电非线性分析在麻醉深度监测中的应用.世界医疗器械.2004.9,10(9):32-35.
[12].吴东宇,贾宝森,尹岭.脑电非线性分析在麻醉深度监测中的应用.解放军医学杂志.2005.1,30(1):40-42.
[13].贾宝森,张宏,米卫东,吴东宇.静脉复合麻醉下异丙酚脑区分布和记忆变化的脑电非线性分析研究.解放军医学杂志.2005.1,30(1):33-36.
[14].张宏,贾宝森,米卫东,吴东宇.静吸复合麻醉下吸入麻醉药物脑区分布和记忆变化的脑电非线性分析研究.解放军医学杂志。2005.1,30(1):29-32.
[15].贾宝森,张宏,吴东宇.脑电非线性分析用于静脉麻醉下异丙酚脑区作用的研究.解放军医学杂志.2005.330(3):250-251
[16].Jessop J,Jones JG.Evaluation of.the actions of general anaesthetics in the human brain.Gen-Pharmacol,1992,23:927-35.
[2]吴东宇,贾宝森,尹岭.脑电非线性分析在麻醉深度监测中的应用.解放军医学杂志,2005,30(1):40
[3]张宏,贾宝森,米卫东等.静吸复合麻醉下吸入麻醉药物脑区分布和记忆变化的脑电非线性分析研究.解放军医学杂志,2005,30(1):29
[4]贾宝森,张宏,米卫东等.静脉复合麻醉下异丙酚脑区分布和记忆变化的脑电非线性分析研究.解放军医学杂志,2005,30(1):33
[5].Pritchard WS,Duke DW.Measuring "Chaos" in the Brain:A Tutorial Review of EEG Dimension Estimation.Brain and Cognitive.1995;27:353-397
[6]Jelles B,van-Birgelen.JH,Slaets JP,et al.Decrease of non-linear structure in the EEG of Alzheimer patients compared to healthy restrains.Clin-Neurophysiol.1999 Jul;110(7):1159-67.
[7]Zhang XS,Roy RJ,Jensen EW.EEG complexity as a measure of depth of anesthesia for patients.IEEE-trans-biomed-Eng.2001 Dec;48(12):1424-1433
[8]Russell IF,Wang M.Absence of memory for intraoperative information during surgery with total intravenous anesthesia.Br J Anesth 2001; 86:196-202.
[9] Kalkman CJ,Boezeman EH,Ribberink AA,et al. Influence of changes in arterial carbon dioxide tension on the electroencephalogram and posterior tibial nerve somatosensory cortical evoked potentials during alfentanil/nitrousoxideanesthesia Anesthesiology 1991,75 :68-74
[10] Kennealy JA, Penovich PE,Moor Nease SE. EEG and spectral analysis in acute hyperventilation. Electroenceph Clin Neurophsiol.6,63:98 106
[11] Xu Nan,Xu Jinghua.The fractal dimension of EEG as a Physical measure of conscious humanbrain activities. Bulletin of Mathematical Biology. 1988,50:559-565.
[12] Bullmore,E.T.,et al.Fractal analysis of electroenc-ephalographic signals intra- cerebrally recorded during 35 epileptic seizures :evaluation of a new method for synoptic visualization of ictal events. Electroenceph. clin.Neurophysiol.1994,91: 337-345.
[13] Roschke,J.,Aldenholf,J. The dimensionality of human's electro-encephalogram during sleep. Biol.Cybern. 1991,64:307-313.
[14] Pritchard,W.S.,etal.EEG-based,neural-net predictive classification of Alzheimer' s diseaseversus control subjects is augmented by non-linear EEG measures.Electroenceph.clin. Neurophysiol.1994,91:118-130.
[15]张宏,贾宝森,米卫东等.静吸复合麻醉下吸入麻醉药物脑区分布和记忆变化的脑电非线性分析研究.解放军医学杂志,2005,30(1):29
[16]韩如泉,王保国,王恩真.不同动脉血二氧化碳分压对数量化脑电图的影响,2000,20:471
[17]韩文斌.M A C的临床研究进展。国外医学麻醉学与复苏分册,1996,17:303
[18]Patel VM,Manlsby RL.How hyperventilation alters the electroencephalogram:a review of controversial viewpoints emphasizing neurophysiological mechanisms.J Clin Neurophysial.1987,4:101-120
[19]欧阳铭文,吴东宇,张宏.异丙酚靶控输注镇静时脑电双频指数和非线性参数变化分析.解放军医学杂志.2006,6.31(6):597-598.
[20]贾宝森.围术期脑电监测系统研究的新进展.军医进修学院博士论文.2005:80-92.
[1]. Lopes-da-Silva FH . Neural Mechanism underlying Brain Wave: from branches to network. Electro-clin-Neurophysiol.1991,79:81-93.
[2]. Pritchard WS, Duke DW. Measuring "Chaos" in the Brain: A Tutorial Review of EEG Dimension Estimation. Brain and Cognitive. 1995,27:353-397.
[3]. Jelles B, van-Birgelen JH, Slaets JP,etal. Decrease of non-linear structure in the EEG of Alzheimer patients compared to healthr controls. Clin-Neurophysiol.1999,16:822-835.
[4]. Jorgen B,Heiko,Ropcke,etal.Approximate entropy as an elect roce nceph-alographic measure of anesthetic drug effect during desflurane anesthesia. Anesthesiology,2000,92:715-726.
[5]. Approximate entropy as an measure of system complexity.Proc Natl Acad Sci USA, 1991,88:2297-2301.
[6]. Roelfsema F,Pincus S M,Veldhuis JD.Patients with cushing'disease secrete adrenocorticotropin and cortisol jointly more asynchronously than healthy subjects.J Clin Endocrinol Metab,1998,83:688-692.
[7]. Makikallio TH,Ristimate T,Airaksinen KE,etal.Heart rate dynamics in patients with stable angina pectoris and utility of fractal and complexity measures. Am J CArdiol, 1998,81:27-31.
[8]. Anthony GH.Effect of volatile anesthetics on interhemispheric EEG cross approximate entropy in the rat.Brain Research,2002,954:123-137.
[9].吴东宇,董为伟.非线性动力学分析在脑电图中的应用.临床神经电生理学杂志.2003.3,12(1):46-51.
[10].吴东宇,董为伟。脑电非线性分析在认知功能研究中的应用.中华神经科杂志.2003.11,36(5):335-338.
[11].吴东宇.脑电非线性分析在麻醉深度监测中的应用.世界医疗器械.2004.9,10(9):32-35.
[12].吴东宇,贾宝森,尹岭.脑电非线性分析在麻醉深度监测中的应用.解放军医学杂志.2005.1,30(1):40-42.
[13].贾宝森,张宏,米卫东,吴东宇.静脉复合麻醉下异丙酚脑区分布和记忆变化的脑电非线性分析研究.解放军医学杂志.2005.1,30(1):33-36.
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