【摘要】 目的评价熵指数预测靶控输注丙泊酚-瑞芬太尼全麻诱导期意识消失的准确性,并与脑电双频指数（BIS）进行比较。方法收集我院2011年10月至12月择期行妇科腹腔镜手术患者50例,全麻诱导采用靶控输注丙泊酚-瑞芬太尼。麻醉诱导期记录每次警觉/镇静评分（the modified observer’s assessment of alertness/sedation,OAA/S）评分即刻的反应熵（RE）、状态熵（SE）、BIS、丙泊酚效应室浓度（Ce）、平均动脉压（MAP）、心率（HR）。分析RE、SE、BIS和Ce与诱导期OAA/S评分的相关性。计算意识消失时的RE、SE的预测概率（P_k）值,并与BIS、Ce、MAP、HR的P_k值比较。分别计算5%、95%患者意识消失时的RE、SE、BIS等指标的有效数值（EC₀5、EC₉5）及其95%可信区间（95%CI）。结果 RE、SE、BIS和Ce与诱导期OAA/S评分均具有相关性（r=0.962、0.951,0.966、-0.983,均P<0.01）。患者意识消失时RE、SE、BIS值分别为60±8、55±9、59±7,三者预测患者意识消失时的Pk值均显著高于0.5,亦高于MAP、HR的Pk值（均P<0.01）。RE、SE、BIS的EC₀5及其95%CI分别为77.3（72.6～85.4）、68.9（65.4～76.2）、72.7（68.1～80.9）,EC95及其95%CI分别为49.5（42.8～52.9）、42.3（33.9～47.0）、46.2（38.3～50.8）。结论熵指数和BIS均能准确预测靶控输注丙泊酚-瑞芬太尼全麻诱导期的意识消失。更多还原

【Abstract】 Objective To evaluate the accuracy of prediction for loss of consciousness (LOC) using entropy index during induction with target-controlled infusing (TCI) propofol-remifentanil general anesthesia. Methods 50 patients undergoing selective gynecologic laparoscopic surgery under general anesthesia induced with TCI propofol-remifentanil from October and December 2011 were included in this study. The values of response entropy (RE), state response (SE), BIS, effect-site concentration of propofol (Ce), mean arterial pressure (MAP) and heart rate (HR) were recoreed at each score of MOAA/S scale. The correlations between RE, SE, BIS, Ce and MOAA/S during induction were analyzed. The P k values of RE、 SE at LOC were calculated and compared with the P k values of BIS, Ce, MAP, HR. The EC 05 , EC 95 values and 95% CI for RE, SE and BIS at LOC were analyzed. Results There were significant correlations between RE, SE, BIS, Ce and MOAA/S during induction (r = 0.962, 0.951, 0.966, -0.983, all P <0.01). The values of RE, SE and BIS at LOC were 60 ± 8, 55 ± 9, 59 ± 7, all with the P k value higher than 0.5 and higher than those of MAP and HR (all P <0.01). The EC 05 values and 95% CI of RE, SE, and BIS at LOC were 77.3 (72.6～85.4), 68.9 (65.4～76.2), 72.7 (68.1～80.9), and the EC 95 values and 95% CI were 49.5 (42.8～52.9), 42.3 (33.9～47.0), 46.2 (38.3～50.8). Conclusions Both entropy and BIS accurately predict consciousness during induction with TCI propofol-remifentanil general anesthesia.更多还原