七氟醚全麻术后青年和老年患者苏醒期的脑电图类别_张欣欣.pdf

书书书临床研究七氟醚全麻术后青年和老年患者苏醒期的脑电图类别张欣欣李傲刘畑畑杨谦梓董海龙DOI:1012089/jca202303001基金项目:国家自然科学基金(82030038)作者单位:710032西安市，空军军医大学第一附属医院麻醉与围术期医学科通信作者:董海龙，Email:hldong6 hotmailcom【摘要】目的研究青年和老年患者在接受七氟醚维持的全麻手术后苏醒期的脑电图(EEG)类别。方法回顾 2018 年 1 月至 2020 年 1 月接受非心脏手术且记录围术期全程 EEG 的患者，根据年龄分为两组:青年组(n=30)和老年组(n=41)。青年组年龄 1938 岁，男 9 例，女 21 例，ASA 或级。老年组年龄 6579 岁，男 20 例，女 21 例，ASA 或级。两组均在完全恢复自主呼吸、咳嗽反射、呼唤可睁眼时拔除气管导管，而后被麻醉科医师送往麻醉恢复室(PACU)观察并记录 30 min前额叶 EEG 信号。采用多窗口谱估计法提取 EEG 信号中、和 四个频段的功率谱，应用聚类算法寻求四个频段功率谱相似的患者，计算轮廓系数得到 PACU 中 EEG 类别最优总数。分析青年组和老年组在各个类别中的数目和四个频段的功率谱大小分布、青年组和老年组特有的 EEG 类别、PACU 中麻醉深度指数(Ai)及 和 振荡功率谱在青年组和老年组中的分布特征。结果青年组和老年组在 PACU 的 Ai 均处于清醒状态区间，青年组的 Ai 明显高于老年组(P0.05)。恢复期 EEG功率谱显示为 6 类，青年组 30%分布在类别，在类别中没有分布。老年组 49%分布在类别中，在类别中没有分布。类别显示最小的 和 功率，类别显示最小 和 功率，类别显示较高的 和 功率，较低的 和 功率。类别和分别是青年和老年患者特有的类别。青年组 87%患者显示高 功率低 功率模式，老年组 73%患者显示较高 功率和 功率的延迟恢复。结论青年组和老年组苏醒期的 EEG 恢复特征存在多个类别，不同的 EEG 类别代表个体从麻醉中的恢复能力。老年患者苏醒期类别主要表现为较高的 和 功率，较低的 和 功率。【关键词】麻醉恢复室;脑电;聚类算法;老年;脑电图类别Electroencephalography categories in the post anaesthesia care unit between young and elderly pa-tients after sevoflurane general anesthesiaZHANG Xinxin，LI Ao，LIU Tiantian，YANG Qianzi，DONG Hailong Department of Anesthesiology and Perioperative Medicine，the First Affiliated Hospital ofthe Air Force Medical University，Xi an 710032，ChinaCorresponding author:DONG Hailong，Email:hldong6 hotmailcom【Abstract】ObjectiveTo investigate the electroencephalogram(EEG)categories in the post an-aesthesia care unit(PACU)between young and elderly patients after sevoflurane general anesthesiaMethodsThis was retrospective cohort study assessing EEG categories in non-cardiac surgical betweenyoung and elderly patients from January 2018 to January 2020 According to the age，patients were dividedinto two groups:young group(n=30)and elderly group(n=41)In the young group，there were 9males and 21 females，aged 1938 years，ASA physical status or，while in the elderly group，therewere 20 males and 21 females，aged 6579 years，ASA physical status or The tracheal tube was re-moved when the patients fully recovered spontaneous breathing，cough reflex，and opened their eyes whenthey were asked to，and were then sent to the PACU by an anesthesiologist，where the patientsperfrontalEEG signals were recorded for 30 minutes The multi-window spectral estimation method was used to extractthe power spectral of，and power，and clustering algorithm were used to find the patients withsimilar spectral power in the four frequency bands The countour coefficient was calculated to obtain the opti-mal total number of EEG categories The distribution of the number and the four frequency bands，the EEGcategories unique to the young and elderly groups，the depth of anesthesia index(Ai)in the PACU and the and the oscillation power spectrum in the young and elderly groups were analyzed esultsThe Ai ofthe two groups were both in the awakening range in the recovery room，but the Ai of the young group wasslightly higher than the elderly group(P 005)EEG patterns could be characterized into six clusters922临床麻醉学杂志 2023 年 3 月第 39 卷第 3 期J Clin Anesthesiol，March 2023，Vol39，No3based on the spectral power of，and 30%of the young group were distributed in category，and none in category In the elderly group，49%were distributed in category and none in category Category and category were characterized by minimal and power or minimal and power，re-spectively Category was characterized by higher and power，lower and power Category was apattern unique to the young patients，and category was a pattern unique to the elderly patients 87%young patients possessed a high low pattern in the PACU，while 73%of the elderly patients intended tosustain a higher power rather than the recovery of power ConclusionThere were multiple categories ofEEG recovery characteristics in the young and elderly groups，and different EEG categories represent the in-dividual s ability to recover from anesthesia Elderly patients mainly showed higher and power and lower and power【Key words】Post anaesthesia care unit;Electroencephalography;Clustering algorithm;Aged;Electroencephalogram categories麻醉深度监护仪已广泛应用于临床，采集的脑电图(electroencephalogram，EEG)可反映患者的意识状态，在麻醉后苏醒阶段 EEG 频谱通常向高频 和 转变1。从麻醉中苏醒涉及不同路径，纺锤波功率 缺 失 的 患 者 更 容 易 在 麻 醉 恢 复 室(post-anesthesia care unit，PACU)表现出谵妄2。老年患者比青年患者在 PACU 的停留时间明显延长，老年患者与青年患者的脑功能恢复速度可能存在差异3。这种差异是否具有 EEG 表征，目前尚不清楚。本研究通过回顾性分析青年患者和老年患者在 PACU 的 EEG 类别及其差异，旨在为不同年龄群体术后脑功能恢复能力提供客观指标。资料与方法一般资料本研究经医院伦理委员会批准(KY20212092-C-1)。回顾性分析 2018 年 1 月至2020 年 1 月全身麻醉下接受非心脏手术且记录了围术期全程 EEG 的患者，性别不限，ASA 或级。根据年龄将患者分为两组:青年组和老年组。青年组年龄 19 38 岁，老年组年龄 65 79 岁。排除标准:初中以下文化水平，中枢神经系统疾病和精神疾病，既往 1 年内有手术史，有严重心脏疾病和肝肾功能障碍，服用镇静药物或抗抑郁药物和长期酒精使用或成瘾史。麻醉方法患者均不予术前用药。入室后用酒精擦拭额头，粘贴电极片连接 Conview 监护仪开始记录 EEG 信号。同时监测 BP、SpO2、ECG 和麻醉深度指数(the depth of anesthesia index，Ai)。开放外周静脉，麻醉诱导:静注丙泊酚 12 mg/kg、舒芬太尼 0.10.5 g/kg，肌松采用罗库溴铵 0.60.8mg/kg、维库溴铵 0.1 mg/kg 或顺式阿曲库铵 0.15mg/kg。Ai 达到 40 60 时进行气管插管。维持期吸入 1.5%2%七氟醚，持续泵注瑞芬太尼 0.1 0.3 gkg1min1，按需求追加肌松药。术中及时调整七氟醚吸入浓度和瑞芬太尼的给药速度，维持 Ai 40 60。采用容量控制通气模式，VT6 8ml/kg，PEEP 6 cmH2O，维持气道压30 cmH2O，维持 PETCO23545 mmHg。术中监测 H