| CSI在成人靶控输注异丙酚麻醉诱导中的监测及评价 |
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| 引用本文： | 潘韫丹,郭曲练,钟涛. CSI在成人靶控输注异丙酚麻醉诱导中的监测及评价[J]. 中南大学学报(医学版), 2006, 31(3): 437-440 |
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| 作者姓名： | 潘韫丹 郭曲练 钟涛 |
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| 作者单位： | 中南大学湘雅医院麻醉科,长沙,410008;中南大学湘雅医院麻醉科,长沙,410008;中南大学湘雅医院麻醉科,长沙,410008 |
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| 摘 要： | 目的：评价麻醉深度指数（cerebral state index，CSI）在靶控输注异丙酚麻醉诱导过程中预测患者麻醉深度的精确程度。方法：40例成人全麻手术患者，ASA（American Society of Anesthesiologists）Ⅰ-Ⅱ级，靶控输注异丙酚诱导，最初血浆靶浓度设置在0．5mg／5min增加0．5mg／L，直至改良清醒镇静（modified observer＇s assessment of alertness／sedation，MOAA／S）评分为0后5min停止。试验中监测患者CSI、平均动脉压（mean arterial pressure，MAP）、心率（heartrate，HR）、MOAA／S评分、靶控输注系统预测效应部位浓度值。结果：（1）CSI值随MOAA／S评分下降而下降，在MOAA／S评分为0至1，1至2，3至4，4至5时CSI值下降均有统计学意义（P〈0．05）。MAP在MOAA／S评分3至2时下降有统计学意义（P〈0．05）。HR在各级MOAA／S评分时差异无统计学意义（P〉0．05）。（2）CSI，MAP，HR与MOAA／S评分的等级相关系数分别为0．929，0．421，0．085。CSI，MAP，HR在区分不同MOAA／S评分时的预测概率（prediction probability，Pk）分别为0．94，0．67，0．54。（3）CSI与异丙酚靶控输注预测效应部位浓度存在线性回归关系（决定系数R^2=0．833，P〈0．01）。结论：在成人患者靶控输注异丙酚平稳麻醉诱导状态下，CSI能够准确地区分清醒和麻醉后的不同意识水平，可靠地预测麻醉深度。
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| 关 键 词： | 清醒镇静 预测 二异丙酚 药物投与系统 |
| 文章编号： | 1672-7347（2006）03-0437-04 |
| 收稿时间： | 2005-07-14 |
| 修稿时间： | 2005-07-14 |
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| PAN Yun-dan,Guo Qu-lian,ZHONG Tao.
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| Authors: | PAN Yun-dan Guo Qu-lian ZHONG Tao |
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| Affiliation: | Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China. |
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| Abstract: | OBJECTIVE: To evaluate the accuracy of cerebral state index (CSI) as an indicator of anesthesia depth in patients in the induction of anesthesia with target-controlled infusion of propofol. METHODS: Forty ASA (American Society of Anesthesiologists) I approximately II patients scheduled for an operation under general anesthesia were anesthetized with target-controlled infusion of propofol. Target plasma concentration was 0. 5 mg/L at the beginning, and increased by 0. 5 mg/L every 5 minutes, till 5 minutes after the level of MOAA/S (modified observer's assessment of alertness/sedation) was 0. The CSI, mean arterial pressure (MAP), heart rate (HR), MOAA/S level, and the effect-site concentration of propofol were recorded. RESULTS: (1) CSI values declined with the decrease of MOAA/S levels. CSI values were statistically different between level 0 and 1, level 1 and 2, level 3 and 4, level 4 and 5 of MOAA/S (P < 0.05). The difference of MAP had statistical significance between level 3 and level 2 of MOAA/S (P < 0.05). HR values had no statistical difference between the two levels of MOAA/S (P > 0.05). (2) The spearman rank correlation co-efficients between CSI, MAP, HR and the level of MOAA/S were 0.929, 0.421, and 0.085, respectively. The prediction probabilities (Pk) to differentiate different levels of MOAA/S for CSI, MAP, and HR were 0.94, 0.67, and 0.54, respectively. (3) There was linear regression relationship between CSI and the effect-site concentration of propofol (the coefficient of determination R2 was 0. 833, P < 0.01). CONCLUSION: During the induction of patients with target-controlled infusion of propofol, the CSI is accurate as an indicator of awakeness and different levels of consciousness after anesthesia, and can reliably predict the anesthesia depth. |
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| Keywords: | conscious sedation forecasting propofol drug delivery systems |
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