文章摘要
手术体积描计指数联合熵指数监测对关节镜肩袖修补术中循环及早期转归的影响
Effect of surgical pleth index combined with entropy monitoring on intraoperative circulation and early outcome of arthroscopic rotator cuff repair patients
  
DOI：10.12089/jca.2021.08.006
中文关键词: 手术体积描计指数  熵指数  麻醉监测  早期转归
英文关键词: Surgical pleth index  Entropy  Anesthesia monitoring  Early outcome
基金项目:
作者单位E-mail
李世锋 315020,宁波市第九医院麻醉科  
黄长顺 宁波市第一医院麻醉科 nbhcs1967@163.com 
陈啸非 315020,宁波市第九医院麻醉科  
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中文摘要:
      
目的 探讨手术体积描计指数（SPI）联合熵指数麻醉深度监测对关节镜肩袖修补患者术中循环及早期转归的影响。
方法 选择择期行关节镜肩袖修补手术患者60例，男31例，女29例，年龄18~65岁，BMI 18~28 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法分为两组：标准组（S组）和多模式组（M组），每组30例。S组术中采用常规监测；M组在S组的基础上联合SPI和熵指数监测[以状态熵（SE）为主要监测参数]。记录瑞芬太尼和丙泊酚用量和调控次数。记录麻醉诱导前（T1）、插管前10 s（T2）、插管完成时（T3）、切皮时（T4）、缝皮时（T1）和拔管时（T6）M组SPI、SE值和两组HR、MAP。记录自主呼吸恢复时间、拔管时间、首次下床活动时间、首次进流食时间和住院时间。记录术后6 h（T7）、12 h（T8）、24 h（T9）、48 h（T10）、1周（T11）及1个月（T12）的加州大学肩关节（UCLA）评分和NRS评分。记录术中知晓、苏醒延迟、术后躁动、术后喉痉挛、术后寒颤、术后恶心呕吐和伤口愈合不良等并发症的发生情况。
结果 与T1时比较，T2—T62、T1时两组HR明显减慢（P＜0.05），T3时两组HR明显增快（P＜0.05），T62、T4、T5时两组MAP明显降低（P＜0.05），T3时S组MAP明显升高（P＜0.05）。与S组比较，M组T2时HR明显增快，MAP明显升高（P＜0.05），T3、T65时MAP明显升高（P＜0.05）；M组瑞芬太尼和丙泊酚用量明显减少（P＜0.01），调控次数明显增加（P＜0.01），自主呼吸恢复时间、拔管时间、首次下床活动时间、首次进流食时间和住院时间明显缩短（P＜0.01）；T9—T10时M组UCLA评分明显升高（P＜0.01），T9—T11时M组NRS评分明显降低（P＜0.01）。两组并发症发生率差异无统计学意义。
结论 SPI联合熵指数能有效监测全麻镇痛和镇静深度，利于指导术中用药，促进肩关节镜手术患者早期康复，不增加并发症。
英文摘要:
      
Objective To explore the effect of multimodal anesthesia depth monitoring based on surgical pleth index (SPI) and entropy on the intraoperative circulation and early outcome of patients with arthroscopic rotator cuff repair.
Methods Sixty patients with arthroscopic rotator cuff repair, 31 males and 29 females, aged 18-65 years, BMI 18-28 kg/m2, ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups: standard group (group S) and multimodal group (group M), with 30 patients in each group. Routine monitoring was used during the operation in group S. SPI and entropy index monitoring were also used in group M with state entropy (SE) as the main monitoring parameter) based on group S. The dosage and regulation times of remifentanil and propofol were recorded. SPI and SE in group M, HR and MAP in two groups of patients during the operation were recorded before anesthesia induction (T1), 10 seconds before intubation (T2), intubation completion (T3), during incision (T4), during suture (T5) and extubation (T67), 12 (T8), 24 (T9), 48 hours (T10), one week (T11), and one month (T12) after surgery. The incidence of complications such as intraoperative awareness, delayed awakening, postoperative restlessness, postoperative laryngeal spasm, postoperative shivering, postoperative nausea and vomiting, and poor wound healing were recorded.
Results Compared with group S, HR and MAP in group M were higher at T2 (P < 0.05), HR and MAP in group M were lower at T3 and T65 was higher (P < 0.05). Compared with T1, the HR in the two groups at T2 and T5 were lower (P < 0.05), the HR in the two groups was higher at T3(P < 0.05), and the HR in group S was higher at T62, T4, and T5(P < 0.05), the MAP in group S was lower at T3(P < 0.05), and the SPI and SE values in group M were lower at T2-T69-T10 was higher, and the NRS score at T9-T11 was lower (P < 0.01). There was no significant difference in the incidence of complications between the two groups.
Conclusion SPI combined with entropy can effectively monitor the analgesia and sedation depth of general anesthesia, which is beneficial to guide intraoperative medication, and promoting early recovery of patients undergoing arthroscopic shoulder surgery without increasing complications.
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