小波指数用于全身麻醉患者术中麻醉深度监测的可行性

目的 评价小波指数(WLI)在全身麻醉(全麻)术中的应用价值.方法 选择2009年3至10月在宣武医院行全麻择期手术患者53例,入室后连接脑电双频谱指数(BIS)、WLI和肌松监测仪,记录入室10 min(T1)、诱导开始即刻(T2)、给予丙泊酚后OAA/S评分分别为5(T3)、4(T4)、3(T5)、2(T6)、1(T7)时、给予维库溴胺后四个成串刺激(TOF)值分别为100(T8)、75(T9)、50(T10)、25(T11)、0(T12)时、插管即刻(T13)、捅管后1 min(T14)、3min(T15)、5min(T16)、手术开始前(T17)、手术开始时(T18)、手术开始后1 min(T19)、3 min(T20)、5min(T21)、缝皮时(T22)、术毕(T23)、拔管时(T24)、拔管后1 min(T25)、5 min(T26)、出室前(T27)的BIS、WLI和TOF值.结果 麻醉诱导期与恢复期(T10 ～ T13,T22～T27)WLI高于BIS(P ＜0.05).经Bland-Altman一致性分析,WLI和BIS在进行麻醉深度监测时一致性在可接受范围内(偏差为-2.99,2SD为21.56％和-29.97％).OAA/S评分与BIS和WLI相关系数分别为rBIS =0.884,rWLI =0.757(P =0.000).结论WLI用于全麻患者术中麻醉深度的监测具有可行性.

Feasibility analysis of wavelet index for monitoring the depth of anesthesia in patients undergoing general anesthesia

Objective To evaluate the value of wavelet index(WLI)in general anesthesia through a comparison of WLI with bispectral index(BIS).Methods A total of 53 patients scheduled for elective surgery with ASA(American Society of Anesthesiologists)Ⅰ-Ⅱ were selected to undergo generalanesthesia.The monitoring probes of BIS,WLI and muscle relaxation were connected in awaking patients.The values of WLI and BIS were recorded at 10 min(T1)entering OR(operating room),immediate before anesthesia induction(T2),when the OAA/S(observer's assessment of alertness/sedation)score declined gradually to 5(T3),4(T4),3(T5),2(T6),1(T7)after the infusion of propofol,after vecuronium given when the TOF value decreased to 100(T8),75(T9),50(T10),25(T11),0(T12)after the injection of vecuronium,tracheal intubation(T13),1 min(T14),3 min(T15)and 5 min(T16)after the completion of tracheal intubation,immediate before initiating surgical procedure(T17),beginning the operation(T18),1 min(T19),3 min(T20),5 min(T21)post-operation,skin suturing(T22),end of surgery(T23),tracheal extubation(T24),1 min(T25)and 5 min(T26)cd post-extubation,immediate before exiting OR (T27).Results The value of WLI at T10-T13,T22-T27 was more than BIS(P ＜ 0.05).The BlandAltman analysis showed that WLI was accepted comparing with BIS during the period of anesthesia.The bias was-2.99,95％ limits of agreement-29.97％ to 21.56％.The correlation coefficients of OAA/S score with BIS and WLI were:rBIs =0.884,rWLI =0.757(P =0.000).Conclusion WLI index is feasible for monitoring the depth of general anesthesia.