雷伟健 黄雪芳 刘锦仪 杨经文

[摘要]目的通過与 Richmond 躁动镇静评分（RASS）比较，评估频谱熵指数，分析该指数对动脉瘤性蛛网膜下腔出血（aSAH）镇静深度监测的价值，评价其可行性。方法在2019年1月至2020年4月，选择广州医科大学附属第六医院 ICU 二区就诊的aSAH介入栓塞术后患者60例，使用丙泊酚和右美托咪定镇静处理，并行量化脑电图监测频谱熵指数，每隔30 min 进行 RASS 评分，并记录同一时间节点的频谱熵指数，观察频谱熵指数与 RASS 评分指标，分析两种指标的相关性。标准绘制受试者工作特征（ROC）曲线为 RASS<-3分，评分以确定镇静适度时所对应的最适频谱熵指数。结果aSAH患者镇静期间频谱熵指数与 RASS 评分呈正相关，相关系数为0.925（ P <0.001），57.045为 ROC 曲线上相对的镇静适度与镇静过度最佳截断点的频谱熵指数，敏感度为83%，特异度为90%，曲线下面积（AUC）指标理想，为0.927。结论 RASS 与频谱熵指数两种指标之间存在明显的相关性，能在临床上用于aSAH患者镇静深度的监测。

[关键词]频谱熵指数; Richmond 躁动镇静;动脉瘤性蛛网膜下腔出血;镇静深度

[中图分类号] R743.35  [文献标识码] A   [文章编号]2095-0616（2022）09-0176-04

Postoperative application of frequency spectrum entropy index to monitor sedation depth in patients with aneurysmal subarachnoid hemorrhage

LEI  Weijian    HUANG  Xuefang    LIU  Jinyi    YANG  Jingwen

Department of Intensive Care Unit， the Sixth Affiliated Hospital of Guangzhou Medical University， Qingyuan People's Hospital， Guangdong， Qingyuan 511500， China

[Abstract] Objective To investigate the feasibility of the frequency spectrum entropy index in monitoring the sedation depth in patients with aneurysmal subarachnoid hemorrhage （aSAH） by comparing it with the Richmond agitation-sedation scale （RASS）. Methods A total of 60 aSAH patients with interventional embolization admitted to the Intensive Care Unit （ICU）Ⅱ of the Sixth Affiliated Hospital of Guangzhou Medical University from January 2019 to April 2020 were selected as study subjects. They were sedated with propofol and dexmedetomidine， and the frequency spectrum entropy index was monitored by quantitative electroencephalogram. The RASS score was evaluated every 30 minutes， and the frequency spectrum entropy index at the same time point was recorded. The correlation between the frequency spectrum entropy index and the RASS score was analyzed， and the optimal frequency spectrum entropy index for moderate sedation was determined by plotting the receiver operating characteristic （ROC） curve with the RASS score <-3 as the standard. Results The frequency spectrum entropy index was positively correlated with the RASS score when aSAH patients were at sedation status， with a correlation coefficient of 0.925（P <0.001）. The spectral entropy at the best cut-off point between moderate and excessive sedation on the ROC curve was 57.045， with a sensitivity of 83%， specificity of 90%， and area under the ROC curve of 0.927. Conclusion The spectral entropy is well correlated with sedation score in RASS， and can be applied clinically to monitor the sedation depth in aSAH patients.

[Key words] Frequency spectrum entropy index; Richmond Agitation-Sedation Scale; Aneurysmal subarachnoid hemorrhage; Sedation depth

动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid hemorrhage，aSAH）患者常常因疼痛、手术创伤、有创插管、机械通气等因素容易造成应激性损伤、再发颅内出血以及人机不协调等风险，镇痛镇静有助于控制患者的焦虑、躁动和疼痛，减轻应激性损伤，提高机械通气的人机协调性[1]。目前，主观评分系统是临床上常见的方法，可应用于镇静深度评价中，其中， Richmond 躁动镇静评分（Richmond agitationand-sedation scale，RASS）是应用最广泛的，其信度与效度均良好，而镇静躁动评分（sedation- agitation scale， SAS）亦具有较好信效度[2-3]。……