国际麻醉学与复苏杂志   2021, Issue (10): 4-4
    
亚麻醉剂量艾司氯胺酮对七氟醚麻醉脑电图特征的影响
刘畑畑, 张芸芸, 张欣欣, 杨谦梓, 董海龙1()
1.西京医院
Effect of subanesthetic s‑ketamine on the electroencephalography pattern of sevoflurane anesthesia
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摘要:

目的 观察亚麻醉剂量艾司氯胺酮对七氟醚全身麻醉下脑电图(electroencephalogram, EEG)特征的影响,寻找能反映艾司氯胺酮复合麻醉的麻醉深度指标。 方法 收集2020年11月至2020年12月于空军军医大学第一附属医院行择期妇科腹腔镜手术的汉族患者10例,采用随机数字表法将患者分为艾司氯胺酮组(K组)和对照组(S组)(每组5例),两组患者于手术开始后30 min分别给予艾司氯胺酮(0.15 mg/kg)和等体积生理盐水。麻醉维持使用七氟醚吸入和瑞芬太尼静脉泵注。观察两组患者基本情况,采集两组患者麻醉全程的EEG数据,对艾司氯胺酮给药前后EEG的边缘频率、麻醉指数(anesthesia index, Ai)和相位幅值耦合的改变进行分析。 结果 两组患者年龄、BMI及给药前后MAP、心率比较,差异均无统计学意义(P>0.05)。K组EEG平均功率谱在给药后低频波功率降低、高频波功率略有增加,具体表现为给药后EEG边缘频率和Ai值较给药前明显增加(P<0.05);S组EEG特征在给药前后差异无统计学意义(P>0.05);K组的边缘频率变化值和Ai变化值明显高于S组(P<0.05)。K组给药前后δ‑α相位幅值耦合强度的变化与S组比较差异无统计学意义(P>0.05)。 结论 亚麻醉剂量艾司氯胺酮能够改变七氟醚全身麻醉的EEG频谱特征,但并不显著影响临床麻醉深度,因此δ‑α相位幅值耦合指标能较为合理地反映亚麻醉剂量艾司氯胺酮复合麻醉的麻醉深度。

关键词: 艾司氯胺酮; 麻醉深度; 边缘频率; 麻醉指数; 相位幅值耦合
Abstract:

Objective To observe the effect of subanesthetic s‑ketamine on the electroencephalography (EEG) pattern of sevoflurane general anesthesia, and to find the proper indicator for evaluating the anesthetic depth of s‑ketamine‑combined anesthesia. Methods A total of 10 Han nationality patients who were scheduled for gynecological laparoscopy in the First Affiliated Hospital of the Air Force Medical University from November 2020 to December 2020 were enrolled. According to the random number table method, they were randomly divided into two groups (n=5): the s‑ketamine group (group K) and the control group (group S). The patients were administered with s‑ketamine (0.15 mg/kg) or normal saline with the same volume 30 min after operation, respectively. Sevoflurane inhalation and remifentanil intravenous pump were used for anesthesia maintenance. Their general information were observed, and EEG data were collected during the whole process of anesthesia. The changes of edge frequency, anesthesia index (Ai) and phase amplitude coupling were analyzed. Results There were no statistical differences in age, body mass index (BMI), mean arterial pressure (MAP) and heart rate between two groups before and after treatment (P>0.05). The mean power spectrum of group K decreased in the low frequency wave and increased in the high frequency wave after administration. Particularly, the edge frequency and Ai value of EEG significantly increased after administration (P<0.05). There was no statistical difference in EEG power spectrum of group S before and after administration (P>0.05). The changes of edge frequency and Ai in group K were significantly higher than that in group S (P<0.05). There was no statistical difference in the coupling strength of δ wave phase and α wave amplitude between group K group and group S (P>0.05). Conclusions The subanesthetic s‑ketamine can change the EEG pattern of sevoflurane general anesthesia, without effects on the depth of clinical anesthesia. δ‑α phase amplitude coupling index may rationally reflect the actual depth of subanesthetic s‑ketamine‑combined anesthesia.

Key words: S‑ketamine; Depth of anesthesia; Spectral edge frequency; Anesthesia index; Phase‑amplitude coupling