Duncan D, Kelly K P, Andrews P J D
Department of Anaesthesia, Critical Care and Pain Medicine, Western General Hospital Crewe Road, Edinburgh EH4 2XU, Scotland, UK.
Br J Anaesth. 2006 May;96(5):590-6. doi: 10.1093/bja/ael064. Epub 2006 Mar 24.
Processed EEG monitoring of anaesthetic depth could be useful in patients receiving general anaesthesia following subarachnoid haemorrhage. We conducted an observational study comparing performance characteristics of bispectral index (BIS) and entropy monitoring systems in these patients.
Thirty-one patients of the World Federation of Neurosurgeons grades 1 and 2, undergoing embolization of cerebral artery aneurysms following acute subarachnoid haemorrhage, were recruited to have both BIS and entropy monitoring during general anaesthesia. BIS and entropy indices were matched to clinical indicators of anaesthetic depth. Anaesthetists were blinded to the anaesthetic depth monitoring indices. Analysis of data from monitoring devices allowed calculation of prediction probability (P(K)) constants, and receiver operating characteristic (ROC) analysis to be performed.
BIS and entropy [response entropy (RE), state entropy (SE)] performed well in their ability to show concordance with clinically observed anaesthetic depth. P(K) values were generally high (BIS 0.966-0.784, RE 0.934-0.663, SE 0.857-0.701) for both forms of monitoring. ROC curve analysis shows a high sensitivity and specificity for all monitoring indices when used to detect the presence or absence of eyelash reflex. Area under curve for BIS, RE and SE to detect the absence or presence of eyelash reflex was 0.932, 0.888 and 0.887, respectively. RE provides earlier warning of return of eyelash reflex than BIS.
BIS and entropy monitoring perform well in patients who receive general anaesthesia after good grade subarachnoid haemorrhage.
对于蛛网膜下腔出血后接受全身麻醉的患者，处理后的脑电图监测麻醉深度可能有用。我们进行了一项观察性研究，比较这些患者中脑电双频指数（BIS）和熵监测系统的性能特征。
招募31例世界神经外科医师联盟1级和2级的患者，在急性蛛网膜下腔出血后接受脑动脉瘤栓塞术，在全身麻醉期间同时进行BIS和熵监测。将BIS和熵指数与麻醉深度的临床指标进行匹配。麻醉医生对麻醉深度监测指数不知情。对监测设备的数据进行分析，以计算预测概率（P(K)）常数，并进行受试者操作特征（ROC）分析。
BIS和熵[反应熵（RE）、状态熵（SE）]在显示与临床观察到的麻醉深度一致性方面表现良好。两种监测形式的P(K)值通常都很高（BIS为0.966 - 0.784，RE为0.934 - 0.663，SE为0.857 - 0.701）。ROC曲线分析显示，当用于检测睫毛反射的有无时，所有监测指数都具有高敏感性和特异性。BIS、RE和SE检测睫毛反射有无的曲线下面积分别为0.932、0.888和0.887。RE比BIS能更早地预警睫毛反射的恢复。
BIS和熵监测在蛛网膜下腔出血分级良好后接受全身麻醉的患者中表现良好。
