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丙泊酚诱导意识丧失与恢复的脑电图特征

Electroencephalogram signatures of loss and recovery of consciousness from propofol.

机构信息

Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.

出版信息

Proc Natl Acad Sci U S A. 2013 Mar 19;110(12):E1142-51. doi: 10.1073/pnas.1221180110. Epub 2013 Mar 4.

Abstract

Unconsciousness is a fundamental component of general anesthesia (GA), but anesthesiologists have no reliable ways to be certain that a patient is unconscious. To develop EEG signatures that track loss and recovery of consciousness under GA, we recorded high-density EEGs in humans during gradual induction of and emergence from unconsciousness with propofol. The subjects executed an auditory task at 4-s intervals consisting of interleaved verbal and click stimuli to identify loss and recovery of consciousness. During induction, subjects lost responsiveness to the less salient clicks before losing responsiveness to the more salient verbal stimuli; during emergence they recovered responsiveness to the verbal stimuli before recovering responsiveness to the clicks. The median frequency and bandwidth of the frontal EEG power tracked the probability of response to the verbal stimuli during the transitions in consciousness. Loss of consciousness was marked simultaneously by an increase in low-frequency EEG power (<1 Hz), the loss of spatially coherent occipital alpha oscillations (8-12 Hz), and the appearance of spatially coherent frontal alpha oscillations. These dynamics reversed with recovery of consciousness. The low-frequency phase modulated alpha amplitude in two distinct patterns. During profound unconsciousness, alpha amplitudes were maximal at low-frequency peaks, whereas during the transition into and out of unconsciousness, alpha amplitudes were maximal at low-frequency nadirs. This latter phase-amplitude relationship predicted recovery of consciousness. Our results provide insights into the mechanisms of propofol-induced unconsciousness, establish EEG signatures of this brain state that track transitions in consciousness precisely, and suggest strategies for monitoring the brain activity of patients receiving GA.

摘要

意识丧失是全身麻醉(GA)的一个基本组成部分,但麻醉师没有可靠的方法来确定患者是否处于无意识状态。为了开发能够跟踪 GA 下意识丧失和恢复的 EEG 特征,我们在人类中记录了高分辨率 EEG,在异丙酚诱导和苏醒过程中逐渐诱导和恢复无意识。受试者以 4 秒的间隔执行一个听觉任务,包括交错的言语和点击刺激,以识别意识的丧失和恢复。在诱导过程中,受试者在对不太明显的点击失去反应之前,对更明显的言语刺激失去反应;在苏醒过程中,他们在对言语刺激恢复反应之前,对点击恢复反应。额部 EEG 功率的中频和带宽跟踪了意识转变过程中对言语刺激的反应概率。意识丧失伴随着低频 EEG 功率的增加(<1 Hz)、空间相干枕部α节律(8-12 Hz)的丧失和空间相干额部α节律的出现。这些动力学随着意识的恢复而逆转。低频相位调制α振幅呈现两种不同的模式。在深度无意识期间,α振幅在低频峰处达到最大值,而在无意识进入和退出期间,α振幅在低频谷处达到最大值。后一种相位-振幅关系预测了意识的恢复。我们的研究结果提供了异丙酚诱导意识丧失机制的深入了解,建立了精确跟踪意识转变的脑状态 EEG 特征,并为监测接受 GA 的患者的大脑活动提供了策略。

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