Department of Anesthesiology, The 1st Hospital of China Medical University, Shenyang, Liaoning 110000, China.
Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning 110801, China.
Comput Math Methods Med. 2022 Mar 11;2022:1080858. doi: 10.1155/2022/1080858. eCollection 2022.
To explore the changes of entropy index and cerebral oxygen metabolism in the maintenance of remifentanil anesthesia and the predictive value of postoperative hyperalgesia.
A total of 266 patients undergoing general anesthesia in our hospital from January 2020 to October 2021 were selected, and remifentanil was used to maintain anesthesia. The state entropy, reaction entropy, and cerebral oxygen metabolism indexes (cerebral oxygen uptake rate (CERO), arterial-venous blood oxygen difference (Da-jvO)) of patients before induction of anesthesia, 15 minutes during the operation, and at the end of the operation were compared. The influencing factors of postoperative hyperalgesia were analyzed. The logistic regression model of postoperative hyperalgesia was established, and the value of entropy index and cerebral oxygen metabolism in predicting postoperative hyperalgesia was evaluated by drawing the receiver operating characteristic curve (ROC).
The state entropy, response entropy, and CERO at 30 min during the operation and at the end of the operation were lower than those before the induction of anesthesia, and Da-jvO was higher than that before the induction of anesthesia ( < 0.001). At the end of the operation, the state entropy, reaction entropy, and CERO were higher than 30 minutes during the operation, and Da-jvO was lower than 30 minutes during the operation ( < 0.001). The dosage of remifentanil, reaction entropy, and CERO at the end of the operation entered the logistic model. The AUC value of the reaction entropy and CERO combined to predict postoperative hyperalgesia at the end of the operation was 0.851 greater than the reaction entropy at the end of the operation ( = 3.847, = 0.036), CERO ( = 2.589, = 0.010) single index predictive value.
The entropy index and cerebral oxygen metabolism in general anesthesia patients change with the progress and discontinuation of remifentanil maintenance anesthesia, and the combination of the two has a high predictive power in postoperative hyperalgesia risk assessment. When the reaction entropy > 54.23, CERO > 34.14%, or the total dosage of remifentanil ≥ 30 g/kg at the end of the operation, we should be highly vigilant of the occurrence of postoperative hyperalgesia and postoperative analgesia management should be strengthened.
探讨熵指数和脑氧代谢在瑞芬太尼维持麻醉中的变化及其对术后痛觉过敏的预测价值。
选取 2020 年 1 月至 2021 年 10 月在我院行全身麻醉的 266 例患者，采用瑞芬太尼维持麻醉。比较患者麻醉诱导前、手术 15 分钟时、手术结束时的状态熵、反应熵和脑氧代谢指标（脑氧摄取率（CERO）、动静脉血氧差（Da-jvO））。分析术后痛觉过敏的影响因素。建立术后痛觉过敏的逻辑回归模型，通过绘制受试者工作特征曲线（ROC）评价熵指数和脑氧代谢对预测术后痛觉过敏的价值。
手术 30 分钟时和手术结束时的状态熵、反应熵和 CERO 均低于麻醉诱导前，Da-jvO 高于麻醉诱导前（<0.001）。手术结束时的状态熵、反应熵和 CERO 均高于手术 30 分钟时，Da-jvO 低于手术 30 分钟时（<0.001）。瑞芬太尼用量、反应熵和手术结束时的 CERO 进入逻辑模型。反应熵和 CERO 联合预测术后痛觉过敏的术后结束时 AUC 值大于反应熵（=3.847，=0.036），CERO（=2.589，=0.010）单指标预测值。
全麻患者的熵指数和脑氧代谢随瑞芬太尼维持麻醉的进展和停止而变化，两者结合对术后痛觉过敏风险评估具有较高的预测能力。当反应熵>54.23、CERO>34.14%或手术结束时瑞芬太尼总用量≥30μg/kg 时，应高度警惕术后痛觉过敏的发生，加强术后镇痛管理。
