应用熵指数监测颅内动脉瘤介入治疗麻醉深度

目的探讨应用熵指数（entropy）进行麻醉深度监测在神经外科介入治疗中使用的可行性及有效性，并与脑电双频谱指数（BIS）进行比较，减少术中知晓发生率。方法40例颅内动脉瘤患者，其中男性22例，女性18例；年龄35—63岁，平均年龄45岁；体质量60～75kg；ASAⅡ～Ⅲ级，动脉瘤分级Ⅱ-Ⅳ级。接受神经外科介入治疗全身麻醉，将患者随机分为A组和B组，每组20例，均应用丙泊酚靶控-阿曲库铵-瑞芬太尼静脉维持麻醉，插入喉罩进行机械通气，A组为对照组，参考血流动力学指标来调节丙泊酚的靶控浓度；B组为熵指数指导组，通过维持熵指数值于40～60来调节丙泊酚的靶控浓度。记录麻醉诱导期警觉／镇静评分（OAA/S评分）、麻醉期间血流动力学指标、熵指数值、BIS、麻醉药物用量、术毕清醒时间及拔管时间。结果40例患者均安全、顺利经过介入治疗过程。状态熵（SE）和反应熵（RE）分别与麻醉诱导期OAA／S评分具良好相关性，相关系数分别为r=0．95和r=0．96（P〈0．01）。与麻醉诱导前比较，熵指数和BIS在诱导后、气管插管及术中均显著下降（P〈0．05），于术毕呼之睁眼时回升，但未达到基础值，SE和RE分别与BIS具有良好相关性，相关系数分别为r=0．92和r=0．90（P〈0．05）。两组血流动力学指标及术毕拔管时间的差异无统计学意义（P〉0．05），B组丙泊酚用量及术毕清醒时间少于A组（P〈0．05），未发现术中知晓。结论熵指数作为一项新的麻醉深度监测指标可被有效地应用于神经外科介入治疗全身麻醉监测，实现给药个体化，减少术中知晓的发生率。

The monitoring of anesthetic degree with entropy in interventional treatment of intracranial aneurysms

Objective To study the effectiveness and feasibility of entropy comparing with bispectral index （BIS） in monitoring the anesthetic degreeundergeneralanesthesiasurgeryininterventional treatment of intracranialaneurysms. Methods Forty patients with ASA Ⅱ - Ⅲ, male 22, female 18, aged 35 - 63 years, mean age 45 years, body weight 60 - 75 kg, aneurysm degree Ⅱ - Ⅳ were performed neurosurgical endovaseular treatment under general anesthesia and randomly divided into 2 groups（n = 20 in each group）. Anesthesia of all patients were maintained with propofol-remifentanil-atraeurium by target- controlled infusion（TCI）, intubatted laryngeal mask airway（LMA） to administer mechanical ventilation. Group A（control group）, according to hemodynamics parameters the TCI concentration of propofol was adjusted; Group B （entropy group）, monitored by BIS at the same time, the TCI concentration of propofol was adjusted by maintaining entropy from 40 to 60. All the following data were recorded, such as observer＇s assessment of alertness/sedation scale （OAA/S） in induction of general anesthesia, hemodynamics data, entropy, BIS, the dosage of anesthetic drug, awaken time and the time of extubatted LMA after operation, whether happened awareness during operation. Results The operation of all patients were safe. The correlation coefficient of state entropy（SE） and response entropy（RE） with OAA/S of induction were r = 0.95 and r = 0.96 respectively （P 〈 0. 01）. The values of entropy and BIS were lower after induction, intubation and during operation than that before induction（P 〈 0. 05）, then they increased when patients opened eyes by anesthetist＇ s order at the end of the operation, but not achieved primitive values. The SE and BIS had positive correlation, RE and BIS also, r = 0.92 and r = 0.90 individually （P 〈 0.05 ）. There was no significant difference between 2 groups on hemodynamics data and the time of extubation after operation （P 〉 0.05）. The dosage of propofol and awaken time after operation of group B were lower than group A （P 〈 0.05）. There was no awareness happened during operation. Conclusion As a new parameter of monitoring the anesthetic degree, entropy can be used effectively under general anesthesia for the operation of endovascular embolization in intracranial aneurysms, to achieve medication individually and reduce awareness rate during operation.