应用脑电非线性分析监测镇静下异丙酚的脑区作用

目的:采用脑电非线性分析监测方法,研究围术期硬膜外复合镇静下异丙酚对不同脑区的作用,探讨其临床价值。方法:20例患者,随机分为异丙酚5mg·kg1·h1、异丙酚6mg·kg1·h1两组(每组10例),麻醉采用硬膜外麻醉复合异丙酚镇静。监测患者围术期的脑电非线性参数—近似熵(ApEn)及关联维数(D2),常规监测BP,HR,SpO2。结果:与入室后相比,镇静下患者均表现为额叶与颞叶区的脑电抑制程度较高。两组患者入室后与镇静下相比较,关联维数、近似熵明显降低,差异有统计学意义(P<0.05);术中与复苏、觉醒相比较,差异有统计学意义(P<0.05),组间比较无明显差异。在复苏与觉醒后,各个脑区的脑电变化表现为:额叶与颞叶区的脑电活动度较高。结论:硬膜外麻醉复合异丙酚镇静下,各个脑区在异丙酚作用下抑制程度是不同的,以额叶和颞叶的抑制程度较高,额叶和颞叶区在复苏觉醒时兴奋程度较高。

The study of propofol effect on brain sections under sedation by EEG non-linear analysis

Objective:To study propofol effect on brain sections under epidural anesthesia combined propofol sedation with EEG non-linear monitor, and discuss the clinical values of EEG non-linear monitor. Methods:20 patients were randomly divided into 2 groups: propofol: 5mg kg~(-1) h~(-1)and propofol: 6mg kg~(-1) h~(-1)group(n=10). The narcosis was maintained by epidural anesthesia and propofol sedation. The EEG non-linear parameters: approximate entropy (ApEn) and correlation dimension (D_(2)) were recorded perioperative periods. The BP, HR, SpO_(2) were monitored routinely. Results:Comparing to entering room, the EEG activities of frontal and temporal cortices after sedation were restrained more than other cortices. Comparing to the data of entering room EEG non-linear parameters (ApEn, D2) in the two experimental groups, significant differences were found in the data of descending EEG non-linear parameters(ApEn, D2) after sedation in the two experimental groups (P<0.05). Comparing to the data of intra-operation in the two experimental groups, the data of EEG non-linear parameters(ApEn, D2) were significantly ascending after resuscitation, awaking in the two experimental groups(P<0.05). There were no significant differences between the two experimental groups. After resuscitation, awaking in the two experimental groups, the EEG activities of frontal and temporal cortices were still regaining more intense than other cortices. Conclusions:Under epidural anesthesia and propofol sedation, the EEG restraining activities of different cortices by propofol were not same, more restraining EEG degree in frontal and temporal cortices, more EEG activities in frontal and temporal cortices after resuscitation, awaking.