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小波指数用于腰-硬联合麻醉下右美托咪定镇静深度监测的有效性 |
Evaluation of wavelet index in monitoring sedation depth with dexmedetomidine under combined spinal-epidural anesthesia |
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DOI:10.12089/jca.2018.12.014 |
中文关键词: 小波指数 腰-硬联合麻醉 警觉/镇静评分 右美托咪定 |
英文关键词: Wavelet index Combined spinal-epidural anesthesia Observational sedation scale Dexmedetomidine |
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中文摘要: |
目的 评价小波指数(Wavelet index, WLi)监测腰-硬联合麻醉下右美托咪定镇静深度的有效性。 方法 选取择期在腰-硬联合麻醉下行下肢骨科手术的患者60例,男42例,女18例,年龄18~60岁,ASA Ⅰ或Ⅱ级。术中使用BIS和WLi监测右美托咪定的镇静深度。选择L2-3或L3-4行腰-硬联合麻醉, 将麻醉平面固定在T10—S5。平面固定后开始静脉输注右美托咪定, 先给予负荷剂量0.75 μg/kg, 10 min恒速输注完, 之后给予维持剂量0.5 μg·kg-1·h-1, 直至手术结束前约15 min停药。记录麻醉平面固定后输注右美托咪定前BIS、WLi、警觉/镇静评分(OAA/S评分)作为基础值。从输注右美托咪定开始直至输注结束, 每5分钟记录一次BIS、WLi值, 每次记录完成后即刻评估OAA/S评分。 结果 BIS、WLi均与OAA/S评分呈正相关, 且具有较好的相关性。BIS与OAA/S评分的相关系数是0.871, WLi与OAA/S评分的相关系数是0.839。WLi与BIS的相关系数为0.783(P<0.05)。BIS、WLi对OAA/S评分的预测概率Pk值分别为0.874和0.857, 均大于0.5(P<0.05)。OAA/S评分≤2分时, BIS的最佳截断值为56.5,敏感度是97.8%, 特异度是89.2%。WLi的最佳截断值为55.8,敏感度是95.6%, 特异度是85%。 结论 WLi能准确地监测腰硬联合麻醉下右美托咪定的镇静深度, 其准确性和BIS相当。 |
英文摘要: |
Objective To assess the accuracy of Wavelet index (WLi) in monitoring sedation depth with dexmedetomidine under combined spinal epidural anesthesia. Methods Sixty patients undergoing lower extremities operation, 42 males and 18 females, aged 18-60 years, ASA physical status Ⅰ or Ⅱ, were enrolled in this study. Both BIS and WLi were used to monitor the sedation depth. The L2-3 or L3-4 intervertebral space was choosen for lumbar-hard anesthesia and the anesthesia plane ranged from T10-S5. After the plane was fixed, the loading dose of dexmedetomidine was administered for 10 min(0.75 μg/kg) and the maintenance dose was 0.5 μg·kg-1·h-1. The administration was stopped 15 minutes before the end of surgery. BIS, WLi and observational sedation scale (OAA/S scores) before the infusion of the dexmedetomidine were recorded as the baseline values. BIS and WLi values were recorded every 5 minutes from the infusion of dexmedetomidine until infusion ended and the OAA/S score was evaluated immediately after each recording was completed. Results BIS and WLi were positively correlated with OAA/S score. The correlation coefficient between BIS and OAA/S score was 0.871 and the correlation coefficient between WLi and OAA/S score was 0.839. The correlation coefficient between WLi and BIS was 0.783 (P < 0.05). The Pk values of BIS and WLi were 0.874 and 0.857 respectively, which were higher than 0.5 (P < 0.05). 3. The calculated cutoff BIS values for OAA/S scores of ≤ 2 were 56.5 (sensitivity 97.8%, specificity 89.2%). The calculated cutoff WLi values for OAA/S scores of ≤ 2 were 55.8(sensitivity 95.6%, specificity 85%). Conclusion WLi can accurately monitor the sedation depth of dexmedetomidine under combined spinal-epidural anesthesia and its accuracy is similar to that of the BIS. |
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