七氟醚与丙泊酚对慢性意识障碍患者全身麻醉期间脑电的影响

doi:10.3877/cma.j.issn.2095-9141.2023.01.003

中华神经创伤外科电子杂志 ›› 2023, Vol. 09 ›› Issue (01) : 12 -18. doi: 10.3877/cma.j.issn.2095-9141.2023.01.003

临床研究

七氟醚与丙泊酚对慢性意识障碍患者全身麻醉期间脑电的影响

李青华¹, 靳晨彦¹, 王艳军¹, 庄禹童², 何江弘³, 郭文治⁴^,^†(

)

^1. 030001　太原，山西医科大学麻醉学院
^2. 510515　广州，南方医科大学第二临床医学院神经外科
^3. 100070　北京，首都医科大学附属北京天坛医院神经外科
^4. 100010　北京，解放军总医院第七医学中心麻醉科

收稿日期:2022-11-08 出版日期:2023-02-15
通信作者: 郭文治

Effects of sevoflurane and propofol on electroencephalography during general anesthesia in patients with prolonged disorders of consciousness

Qinghua Li¹, Chenyan Jin¹, Yanjun Wang¹, Yutong Zhuang², Jianghong He³, Wenzhi Guo⁴^,^†()

^1. College of Anesthesiology, Shanxi Medical University, Taiyuan 030001, China
^2. Department of Neurosurgery, The Second Clinical College of Southern Medical University, Guangzhou 510515, China
^3. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
^4. Department of Anesthesiology, The Seventh Medical Center of PLA General Hospital, Beijing 100010, China

Received:2022-11-08 Published:2023-02-15
Corresponding author: Wenzhi Guo
Supported by:
National Natural Science Foundation of China(81771128)

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引用本文：

李青华, 靳晨彦, 王艳军, 庄禹童, 何江弘, 郭文治. 七氟醚与丙泊酚对慢性意识障碍患者全身麻醉期间脑电的影响[J]. 中华神经创伤外科电子杂志, 2023, 09(01): 12-18.

Qinghua Li, Chenyan Jin, Yanjun Wang, Yutong Zhuang, Jianghong He, Wenzhi Guo. Effects of sevoflurane and propofol on electroencephalography during general anesthesia in patients with prolonged disorders of consciousness[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2023, 09(01): 12-18.

目的

探讨七氟醚吸入麻醉与丙泊酚静脉麻醉对慢性意识障碍（pDoC）患者围术期脑电的影响。

方法

前瞻性纳入解放军总医院第七医学中心神经外科和首都医科大学附属天坛医院神经外科自2022年1月至8月拟行短程脊髓电刺激术（st-SCS）的20例pDoC患者，按照随机数字表法分为七氟醚组（10例）和丙泊酚组（10例）。采用19通道脑电设备记录2组患者麻醉前、麻醉中、麻醉后3个时间段全脑的脑电活动变化。

结果

2组患者麻醉中的脑电功率谱均以δ功率增加，θ、β、γ功率减少为特征。麻醉后，七氟醚组较丙泊酚组有更多的快波活动（θ+α+β）和更少的慢波活动（δ）。脑电指标区分清醒和麻醉状态的ROC曲线显示，以额叶区域的置换熵（PE）和置换Lempel-Ziv复杂度（PLZC）指标区分度最好，丙泊酚额叶PE（AUC：0.865）大于七氟醚额叶PE（AUC：0.815），丙泊酚额叶PLCZ（AUC：0.865）大于七氟醚（AUC：0.810）。

结论

七氟醚与丙泊酚对pDoC患者麻醉状态的脑电活动影响是类似的，但七氟醚组比丙泊酚组具有更好的苏醒后表现。脑电监测对评估全麻期间意识状态有重要意义，快慢波功率比值、PE、PLZC等作为表征麻醉深度的脑电指标在pDoC患者中表现出较强的适用性，额叶区域的PE和PLZC区分清醒和麻醉的能力最强。

关键词: 慢性意识障碍, 七氟醚, 丙泊酚, 脑电图

Objective

To investigate the effects of sevoflurane inhalation anesthesia and propofol intravenous anesthesia on electroencephalogram (EEG) in patients with prolonged disorders of consciousness (pDoC) during perioperative period.

Methods

Twenty patients with pDoC who planned to undergo short-range electrical stimulation of the spinal cord (st-SCS) in Neurosurgery Department of The Seventh Medical Center of PLA General Hospital, and the Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University from January to August 2022, were prospectively included, and divided into sevoflurane group (10 cases) and propofol group (10 cases) according to the random number table. The 19-channel EEG equipment was used to record the changes of brain electrical activity before, during and after anesthesia in both groups.

Results

The EEG power spectra during anesthesia in both groups were characterized by an increase in δ power and a decrease in θ, β and γ power. After anesthesia, sevoflurane group had more fast wave activity (θ+α+β) and less slow wave activity (δ) than propofol group. The area under the ROC curve of EEG indicators which distinguish awake and anesthesia states showed that permutation entropy (PE) and permutation Lempel-Ziv complexity (PLZC) in the frontal lobe region were the best indicators of discrimination, propofol frontal lobe PE (AUC: 0.865) >sevoflurane frontal lobe PE (AUC: 0.815), propofol frontal lobe PLCZ (AUC: 0.865) >sevoflurane (AUC: 0.810).

Conclusion

Sevoflurane and propofol have similar effects on brain electrical activity in pDoC patients under anesthesia, but sevoflurane group has better performance than propofol group after awakening. EEG monitoring is of great significance to evaluate the state of consciousness during general anesthesia. The ratio of fast and slow wave power, PE and PLZC as EEG indicators to describe the depth of anesthesia shows strong applicability in patients with prolonged disorders of consciousness. The PE and PLZC of frontal lobe can distinguish awake from anesthesia best.

Key words: Prolonged disorders of consciousness, Sevoflurane, Propofol, Electroencephalogram

表1 2组患者的一般资料比较

Tab.1 Comparison of general data of the two groups

项目	七氟醚组（n=10）	丙泊酚组（n=10）	χ²/t/Z值	P值
性别[例（%）]				1.000
男	8（80）	8（80）
女	2（20）	2（20）
病因[例（%）]				0.193
颅脑外伤	5（50）	1（10）
脑卒中	3（30）	6（60）
缺氧性脑病	2（20）	3（30）
年龄（岁，±s）	33.9±12.1	37.4±11.1	0.674	0.509
病程[d，M（P₂₅，P₇₅）]	142.50（84.75，165.75）	113.50（75.75，153.25）	-0.529	0.631

表1 2组患者的一般资料比较

Tab.1 Comparison of general data of the two groups

项目	七氟醚组（n=10）	丙泊酚组（n=10）	χ²/t/Z值	P值
性别[例（%）]				1.000
男	8（80）	8（80）
女	2（20）	2（20）
病因[例（%）]				0.193
颅脑外伤	5（50）	1（10）
脑卒中	3（30）	6（60）
缺氧性脑病	2（20）	3（30）
年龄（岁，±s）	33.9±12.1	37.4±11.1	0.674	0.509
病程[d，M（P₂₅，P₇₅）]	142.50（84.75，165.75）	113.50（75.75，153.25）	-0.529	0.631

图1 2组患者麻醉前、中、后的平均脑地形图A：七氟醚组；B：丙泊酚组

Fig.1 The average brain topography of the two groups before, during, and after anesthesia

图2 2组患者麻醉前、中、后的脑电相对功率谱变化A：七氟醚组；B：丙泊酚组；与麻醉前比较，^aP<0.05

Fig.2 Changes in relative power spectra before, during, and after anesthesia in two groups

图3 麻醉前（T0）、中（T1）、后（T2）快慢波功率比值变化

Fig.3 Changes in fast and slow wave power ratios before (T0), during (T1), and after (T2) anesthesia

图4 丙泊酚与七氟醚额叶PE、PLCZ的ROC曲线

Fig.4 ROC curves of PE and PLCZ in the frontal lobe between propofol and sevoflurane

表2 区分清醒、麻醉状态的脑电指标

Tab.2 EEG indicators that distinguish awake from anesthetized states

指标	AUC区域	标准误	渐近显著性	95%CI
指标	AUC区域	标准误	渐近显著性	下限	上限
额叶PE	0.845	0.052	0.000	0.743	0.947
额叶PLCZ	0.845	0.054	0.000	0.739	0.951
顶叶PE	0.815	0.059	0.000	0.699	0.931
顶叶PLCZ	0.811	0.062	0.000	0.690	0.932
枕叶PE	0.805	0.064	0.000	0.680	0.930
枕叶PLCZ	0.793	0.068	0.000	0.660	0.925
枕叶（α+β+θ）/δ	0.788	0.061	0.000	0.668	0.907
中央区PE	0.781	0.063	0.000	0.657	0.905
中央区PLCZ	0.781	0.064	0.000	0.655	0.907
顶叶（α+β+θ）/δ	0.781	0.062	0.000	0.659	0.903
中央区（α+β+θ）/δ	0.763	0.064	0.001	0.636	0.889
额叶（α+β+θ）/δ	0.743	0.066	0.002	0.613	0.872
枕叶（α+β）/（θ+δ）	0.721	0.072	0.006	0.579	0.863
顶叶（α+β）/（θ+δ）	0.719	0.072	0.006	0.578	0.860
中央区（α+β）/（θ+δ）	0.709	0.074	0.009	0.563	0.854
顶叶α/δ	0.704	0.071	0.011	0.565	0.842
枕叶α/δ	0.703	0.072	0.011	0.562	0.843

表2 区分清醒、麻醉状态的脑电指标

Tab.2 EEG indicators that distinguish awake from anesthetized states

指标	AUC区域	标准误	渐近显著性	95%CI
指标	AUC区域	标准误	渐近显著性	下限	上限
额叶PE	0.845	0.052	0.000	0.743	0.947
额叶PLCZ	0.845	0.054	0.000	0.739	0.951
顶叶PE	0.815	0.059	0.000	0.699	0.931
顶叶PLCZ	0.811	0.062	0.000	0.690	0.932
枕叶PE	0.805	0.064	0.000	0.680	0.930
枕叶PLCZ	0.793	0.068	0.000	0.660	0.925
枕叶（α+β+θ）/δ	0.788	0.061	0.000	0.668	0.907
中央区PE	0.781	0.063	0.000	0.657	0.905
中央区PLCZ	0.781	0.064	0.000	0.655	0.907
顶叶（α+β+θ）/δ	0.781	0.062	0.000	0.659	0.903
中央区（α+β+θ）/δ	0.763	0.064	0.001	0.636	0.889
额叶（α+β+θ）/δ	0.743	0.066	0.002	0.613	0.872
枕叶（α+β）/（θ+δ）	0.721	0.072	0.006	0.579	0.863
顶叶（α+β）/（θ+δ）	0.719	0.072	0.006	0.578	0.860
中央区（α+β）/（θ+δ）	0.709	0.074	0.009	0.563	0.854
顶叶α/δ	0.704	0.071	0.011	0.565	0.842
枕叶α/δ	0.703	0.072	0.011	0.562	0.843

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Effects of sevoflurane and propofol on electroencephalography during general anesthesia in patients with prolonged disorders of consciousness

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Effects of sevoflurane and propofol on electroencephalography during general anesthesia in patients with prolonged disorders of consciousness