熵指数应用于非体外循环冠脉搭桥手术麻醉的临床研究

【目的】探讨熵指数（En）在非体外循环冠脉搭桥手术（OPCAB）麻醉应用的可行性。【方法】择期在异丙酚-舒芬太尼麻醉全身麻醉下行OPCAB患者70例，随机分成试验组和对照组，每组35例。试验组在En监测下，调整异丙酚、舒芬太尼输注速率使手术过程状态熵（SE）维持在45～55，反应熵（RE）-SE差小于10；对照组患者维持心率（HR）和血压（BP）变化不超过基础值的25％。记录手术过程、麻醉药用量、拔管时间、在ICU停留时间、住院时间、术中知晓情况等。测量患者血浆促肾上腺皮质激素（ACTH）和皮质醇浓度。【结果】试验组麻醉过程中SE平均数为50±5，显著高于对照组（P〈0．05）；与对照组比较，试验组异丙酚、舒芬太尼用量显著减少（P〈0．05），拔管时间显著减小，但血管活性药物用量显著减少（P〈0．05），但两组患者ACTH和皮质醇浓度比较无显著差异（P〉0．05），均无术中知晓发生。【结论】熵指数监测指导0PCAB麻醉安全可行，可以减少麻醉药用量。

Clinical Study of Entropy Index Applied in Anesthesia for Off-pump Coronary Artery Bypass Grafting Surgery

[Objective]To explore the feasibility of entropy（En） used in anesthesia for off-pump coronary artery bypass grafting（OPCAB） surgery. [Methods]Totally 70 patients scheduled for OPCAB under general anesthesia with propofol-sufentanil were randomly divided into experiment group and control group with 35 patients in each group. In experiment group, propofol and sufentanil infusion rates under En monitoring were regulated to maintain an state entropy（SE） value at 45-55 and response entropy（RE）-SE difference below 10 units. In control group, patients were anesthetized to keep heart rate（HR） and blood pressure（BP） within 25% of the baseline values. The process of operation, the dose of anesthetics, extubation time, the stay time in 1CU, hospitalization time and intraoperative consciousness were recorded. Plasma levels of adrenocortico- tropic hormone（ACTH） and cortisol in patients were measured. [Results]The mean SE in experiment group during anesthesia was 50±5, which was significantly higher than that in control group（ P〈0.05）. Compared with control group, the dosage of propofol and sufentanil in experiment group decreased significantly（ P〈0.05） ,and extubation time was significantly shorten, and the dosage of vasoactive drugs obviously reduced（ P〈0. 05）. There was no significant difference in ACTH and cortisol levels between 2 groups（ P 〉0.05）. No intraoperative consciousness occurred. [Conclusion]En monitoring for guiding OPCAB anesthesia is safe and feasible, and can reduce the consumption of propofol and sufentanil.