【摘要】 目的探讨维库溴铵肌松状态下听觉诱发电位指数(AAI)预测觉醒状态(Wakefulness)恢复与消失的可能性。方法选择14例美国麻醉医师协会(ASA)体格分级Ⅰ~Ⅱ级在单纯全麻下行择期手术的成年患者。以丙泊酚和维库溴铵诱导麻醉,气管插管。采用孤立前臂技术判定觉醒状态的恢复与消失。觉醒状态恢复后,以每小时10mg/kg持续静注丙泊酚直至觉醒状态再次消失。使用A-lineTM无创麻醉深度监护仪连续监测AAI。结果觉醒状态恢复前、后30s内和觉醒状态消失前、后30s内,AAI值分别为24.6±5.0、32.1±7.3、33.4±9.6和21.1±5.9。觉醒状态存在时AAI值明显大于觉醒状态消失后(P<0.001)。预测觉醒状态恢复和消失的Pk值分别是0.786和0.864。观察者操作特性(ROC)曲线下面积为0.926(SE0.002,95%CI0.922-0.931)。觉醒状态恢复概率为5%、50%和95%的AAI值分别是19(4.96%)、29(50.25%)和39(95.14%)。结论AAI可以作为肌松状态下监测觉醒状态恢复和消失的指标,且监测消失过程可能更为可靠。更多还原

【Abstract】 Purpose To assess the performance of the A-line^TM ARX-index（AAI） on detecting the recovery and loss of wakefulness in anesthetized and paralyzed patients. Methods Fourteen adult patients undergoing elective surgery,American Society of Anesthesiologists（ASA） physical status Ⅰ-Ⅱ,were anesthetized with propofol and vecuronium.Wakefulness was measured by the ability of the patient to respond to commands using the isolated forearm technique（IFT）.After the patient responded,propofol was infused at 10 mg·kg^-1·h^-1 until wakefulness was lost again.AAI was recorded continuously and analyzed off-line. Results The AAI showed a significant difference between the values registered 30 s before and 30 s after the recovery of wakefulness,and also between 30 s before and 30 s after the loss of wakefulness.The prediction probability（P_k） values for AAI were 0.786 and 0.864 during the transitions from unresponsiveness to wakefulness and from wakefulness to unresponsiveness.The area under the receiver operating characteristic（ROC） curve for the responsive and unresponsive values was 0.926（SE 0.002,95% CI 0.922-0.931）,and the AAI values of 5%,50% and 95% predicted probability of wakefulness were 19（4.96%）,29（50.25%） and 39（95.14%）,respectively. Conclusions AAI may be a good predictor of recovery and loss of wakefulness for anesthetized and paralyzed patients.更多还原