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术中知晓预防和脑电监测专家共识(2021年)

2021-08-05 14:25:51

<section data-id="103212" data-tools="135编辑器" style="max-width: 100%; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><section hm_fix="421:321" style="margin: 10px auto; padding-top: 20px; padding-bottom: 10px; max-width: 100%; box-sizing: border-box; text-align: center; background-color: rgb(244, 246, 255); overflow-wrap: break-word !important;"><section style="margin-top: 10px; padding-right: 10px; padding-left: 10px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><section data-autoskip="1" style="padding: 20px 30px; max-width: 100%; box-sizing: border-box; background-color: rgb(255, 255, 255); text-align: justify; line-height: 1.75em; letter-spacing: 1.5px; font-size: 14px; overflow-wrap: break-word !important;"><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;">近年来,美国麻醉医师协会提出的麻醉目标为避免术中知晓,维持理想的血流动力学,最佳的麻醉恢复质量,避免术后认知功能障碍及避免围术期死亡。围术期麻醉深度过浅或过深可增加术中知晓和术后并发症,基于脑电信号分析的麻醉深度监测已被广泛用于临床麻醉和科学研究中。本专家共识就术中知晓的预防和脑电监测的应用予以总结和概括,以期为临床麻醉工作提供参考。</p></section></section></section></section><section data-role="paragraph" style="max-width: 100%; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><section data-tools="135编辑器" data-id="101861" style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin-top: 10px; margin-bottom: 10px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="padding: 20px 10px; max-width: 100%; box-sizing: border-box; border-width: 1px; border-style: solid; border-color: rgb(155, 167, 237); overflow-wrap: break-word !important;"><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p></section><section data-role="paragraph" style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section data-tools="135编辑器" data-id="99660" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 10px auto; max-width: 100%; text-align: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="max-width: 100%; display: inline-block; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="padding-right: 10px; max-width: 100%; box-sizing: border-box; display: flex; justify-content: center; align-items: center; overflow-wrap: break-word !important;"><section style="max-width: 100%; display: flex; justify-content: center; align-items: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section data-original-title="" title="" data-num="5" style="max-width: 100%; box-sizing: border-box; width: 45px; height: 45px; background: rgb(237, 245, 255); line-height: 45px; color: rgb(11, 121, 255); border-radius: 100%; font-size: 18px; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">1</strong></section><section style="margin-left: -10px; max-width: 100%; box-sizing: border-box; width: 80px; height: 25px; background: rgb(237, 245, 255); overflow: hidden; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section></section><section data-brushtype="text" style="margin-left: -60px; max-width: 100%; font-size: 16px; letter-spacing: 1.5px; color: rgb(11, 121, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">术中知晓的定义和基本概念</strong></section></section><section style="margin-top: -5px; max-width: 100%; display: flex; justify-content: flex-end; align-items: flex-start; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section data-width="38%" style="max-width: 100%; box-sizing: border-box; width: 104.5px; height: 2px; background: rgb(11, 121, 255); overflow: hidden; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section></section></section></section></section><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; text-align: left; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="letter-spacing: 0.544px; text-align: justify; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000"><span style="font-size:18px">(1)术中知晓(inteaoperative awareness)</span></font></strong></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; text-align: left; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="color: rgb(204, 0, 0); letter-spacing: 0.544px;"><br></strong></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">确切地说应该称之为全身麻醉下的手术中知晓。在本共识中,术中知晓定义为全麻下的患者在手术过程中出现了有意识(conscious)的状态,并且在术后可以回忆(recall)起术中发生的与手术相关联的事件。</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000">(2)意识</font></strong></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">意识被定义为患者能够在其所处的环境下处理外界信息的一种状态。麻醉科医师判断患者的意识是否存在,通常是观察患者对各类刺激是否存在有目的的反应。例如,对指令反应的睁眼和对疼痛刺激的体动。但如使用了肌肉松弛药,则很难观察到患者这种有目的的反应。</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000">(3)记忆</font></strong></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#333333">可以分为</font><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000">外显记忆</font></strong><font color="#333333">(explicit memory)和</font><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000">内隐记忆</font></strong><font color="#333333">(implicit memory)。就全麻患者而言,外显记忆指患者能够回忆起全麻期间所发生的事件。内隐记忆指患者并不能够回忆起全麻期间所发生的事件,但某些术中发生的特定事件能够导致患者术后在操作能力(performance)或行为(behavior)方面发生变化。术中知晓严格上讲应包括外显记忆和内隐记忆。但是,除非患者术后表现出明显的精神心理方面的障碍,否则判断患者术中有无内隐记忆的发生,只能用词干补笔等心理学的专门测试方法。因此,</font><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000">本共识对术中知晓只限定为外显记忆,并不包括内隐记忆</font></strong><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000">;</font></strong><font color="#333333">也不包括全麻诱导入睡前和全麻苏醒之后所发生的事件。术中做梦也不认为是术中知晓。</font></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000">意识和记忆是大脑两个相互关联又相互独立的功能。</font></strong><font color="#333333">患者在术中存在意识或能够按要求完成某些指令性动作,并不意味着其一定能够在术后回忆起相关事件。研究表明,脊柱侧弯矫形手术的患者,对术中唤醒试验的知晓率仅为16.7%左右。同样,全麻术中应用前臂隔离技术可以按指令完成动作的患者术后很少能回忆起相关的术中事件。作为临床麻醉并发症之一的术中知晓,需同时满足术中存在意识和术后回忆起术中事件这两项条件。</font></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">确定一个患者是否发生术中知晓,除听取患者陈述外,还需要与参与该患者麻醉和手术的医师核实;并需要一个由若干专家组成的小组来鉴别知晓或可疑知晓。</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000">(4)改良的Brice调查问卷用于术中知晓的术后调查</font></strong></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;">①What is the last thing you remembered before you went to sleep?</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;">(在入睡前你所记得的最后一件事是什么?)</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;">②What is the first thing you remembered when you woke up?</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;">(在醒来时你所记得的第一件事是什么?)</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;">③Can you remember anything between these two periods?</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;">(在这两者间你还记得什么?)</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;">④Did you dream during your operation?</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;">(在手术中你做过梦吗?)</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;">⑤What was the worst thing about your operation?</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;">(有关这次手术,你感觉最差的是什么?)</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000">(5)术中知晓的调查时机</font></strong></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(0, 0, 0); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; max-inline-size: 100%; cursor: text; caret-color: rgb(255, 0, 0); line-height: 25.5px; font-family: 微软雅黑, sans-serif; box-sizing: border-box !important; overflow-wrap: break-word !important; outline: none 0px !important;">调查用语的不同,会导致调查结果出现差异。另外,如果术中知晓对患者没有造成影响,患者也可能不会主动报告。术中知晓的记忆可能延迟,只有1/3的术中知晓病例是在出PACU前确定的;另有约1/3的术中知晓病例是在术后1~2周才报告的,大部分患者在术后24h内发出报告。</p><p style="color: rgb(0, 0, 0); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; max-inline-size: 100%; cursor: text; caret-color: rgb(255, 0, 0); line-height: 25.5px; font-family: 微软雅黑, sans-serif; box-sizing: border-box !important; overflow-wrap: break-word !important; outline: none 0px !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; max-inline-size: 100%; cursor: text; caret-color: rgb(255, 0, 0); line-height: 25.5px; font-family: 微软雅黑, sans-serif; box-sizing: border-box !important; overflow-wrap: break-word !important; outline: none 0px !important;"><strong style="max-width: 100%; max-inline-size: 100%; cursor: text; box-sizing: border-box !important; overflow-wrap: break-word !important; outline: none 0px !important;"><font color="#cc0000">推荐意见1</font></strong>:使用改良的Brice调查问卷用于术中知晓的术后调查。调查时机应包括术后第一天和一周左右两个时间点(A级)。</p><section data-role="paragraph" style="max-width: 100%; letter-spacing: 0.544px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><section data-tools="135编辑器" data-id="99660" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 10px auto; max-width: 100%; text-align: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="max-width: 100%; display: inline-block; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="padding-right: 10px; max-width: 100%; box-sizing: border-box; display: flex; justify-content: center; align-items: center; overflow-wrap: break-word !important;"><section style="max-width: 100%; display: flex; justify-content: center; align-items: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="max-width: 100%; box-sizing: border-box; width: 45px; height: 45px; background: rgb(237, 245, 255); line-height: 45px; color: rgb(11, 121, 255); border-radius: 100%; font-size: 18px; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">2</strong></section><section style="margin-left: -10px; max-width: 100%; box-sizing: border-box; width: 80px; height: 25px; background: rgb(237, 245, 255); overflow: hidden; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section></section><section data-brushtype="text" style="margin-left: -60px; max-width: 100%; font-size: 16px; letter-spacing: 1.5px; color: rgb(11, 121, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">术中知晓的发生率及潜在危害</strong></section></section><section style="margin-top: -5px; max-width: 100%; display: flex; justify-content: flex-end; align-items: flex-start; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section data-width="38%" style="max-width: 100%; box-sizing: border-box; width: 111.141px; height: 2px; background: rgb(11, 121, 255); overflow: hidden; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section></section></section></section></section><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">(</strong>1)术中知晓的发生率</font></strong></p></section></section><section data-role="paragraph" style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">近年来,国外报道的术中知晓发生率为0.1%~0.4%,高危人群(接受心脏手术、剖宫产术、神经外科创伤急诊手术的患者和休克患者,耳鼻喉等短效手术患者等)可高达1%以上,年轻女性尤为高危人群。国内单中心、小样本研究报道术中知晓发生率高达1.5%~2.0%。儿童术中知晓的调查比较特殊,术中知晓发生率在0.2%~1.2%,高于成人。全麻下行剖宫产的产妇术中知晓发生率约为0.26%。</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">&nbsp;&nbsp;&nbsp;&nbsp;</p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; max-inline-size: 100%; cursor: text; box-sizing: border-box !important; overflow-wrap: break-word !important; outline: none 0px !important;"><font color="#cc0000">推荐意见2</font></strong><font color="#333333">:术中知晓的发生率虽只有0.1%~0.4%,但基于每年巨大的全麻手术量,特别是对于高危人群,术中知晓发生的实际数量应该引起麻醉科医师高度重视(A级)。</font></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">&nbsp;&nbsp;&nbsp;&nbsp;</p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">(</strong>2)术中知晓的潜在危害</font></strong></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">发生术中知晓可引起严重的情感和精神(心理)健康问题,据报道高达30%~71%的术中知晓患者出现创伤后应激综合征(Post-Traumatic Stress Disorder,PTSD),症状持续平均4.7年。此外,患者常有听觉、痛觉、麻痹、焦虑、甚至濒死、窒息等记忆。70%经历术中知晓的患者术后会出现睡眠障碍、噩梦、回想、焦虑,惧怕手术甚至拒绝医疗服务等情况。</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">术中知晓所造成的严重精神/医学法律问题,近年已发展成为一个社会问题。1999年和2006年ASA已结案的索赔医疗纠纷(ASA closed claims)中,术中知晓的投诉占1.9%(1999年为79/4183例,2006年为129/6811例)。</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; max-inline-size: 100%; cursor: text; box-sizing: border-box !important; overflow-wrap: break-word !important; outline: none 0px !important;"><font color="#cc0000">推荐意见3</font></strong><font color="#333333">:应重视术中知晓引起的严重情感和精神(心理)健康问题(B级)。</font></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><section data-tools="135编辑器" data-id="99660" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 10px auto; max-width: 100%; text-align: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="max-width: 100%; display: inline-block; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="padding-right: 10px; max-width: 100%; box-sizing: border-box; display: flex; justify-content: center; align-items: center; overflow-wrap: break-word !important;"><section style="max-width: 100%; display: flex; justify-content: center; align-items: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section data-num="2" style="max-width: 100%; box-sizing: border-box; width: 45px; height: 45px; background: rgb(237, 245, 255); line-height: 45px; color: rgb(11, 121, 255); border-radius: 100%; font-size: 18px; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">3</strong></section><section style="margin-left: -10px; max-width: 100%; box-sizing: border-box; width: 80px; height: 25px; background: rgb(237, 245, 255); overflow: hidden; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section></section><section data-brushtype="text" style="margin-left: -60px; max-width: 100%; font-size: 16px; letter-spacing: 1.5px; color: rgb(11, 121, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">术中知晓的发生机制和危险因素</strong></section></section><section style="margin-top: -5px; max-width: 100%; display: flex; justify-content: flex-end; align-items: flex-start; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section data-width="38%" style="max-width: 100%; box-sizing: border-box; width: 117.797px; height: 2px; background: rgb(11, 121, 255); overflow: hidden; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section></section></section></section></section><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">(</strong>1)病史和麻醉史&nbsp;&nbsp;</font></strong></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">有术中知晓发生史、大量服用或滥用药物(阿片类药、苯二氮䓬类药和可卡因)、慢性疼痛患者使用大剂量阿片类药物史、预计或已知有困难气道、ASA 4~5级、血流动力学储备受限的患者。</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">(</strong>2)手术类型&nbsp;&nbsp;</font></strong></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">全身麻醉手术均有可能发生,其中以心脏手术、剖宫产术、颅脑创伤手术、耳鼻喉手术、急症手术等发生率更高。</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">(</strong>3)麻醉管理&nbsp;&nbsp;</font></strong></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">全凭静脉麻醉、N2O-阿片类药物的麻醉、肌松药的使用、催眠药物用量不足、没有预先给予苯二氮䓬类药物。</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">目前,仍缺乏儿童术中知晓危险因素的大样本研究。国外学者通过综合5项独立的儿童术中知晓调查,提出使用N2O麻醉和气管插管是儿童知晓的危险因素。&nbsp;</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000"><strong style="max-width: 100%; max-inline-size: 100%; cursor: text; box-sizing: border-box !important; overflow-wrap: break-word !important; outline: none 0px !important;">推荐意见</strong><strong style="max-width: 100%; max-inline-size: 100%; cursor: text; box-sizing: border-box !important; overflow-wrap: break-word !important; outline: none 0px !important;">4</strong></font><font color="#333333">:虽然导致术中知晓的发生机制和危险因素尚未最终确定,但高危患者术中知晓的发生率较普通患者增加5~10倍,即从0.1%~0.4%增加至1%。麻醉科医师必须从病史、麻醉史、手术类型和麻醉管理等方面识别术中知晓的危险因素(A级)。</font></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><section data-tools="135编辑器" data-id="99660" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 10px auto; max-width: 100%; text-align: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="max-width: 100%; display: inline-block; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="padding-right: 10px; max-width: 100%; box-sizing: border-box; display: flex; justify-content: center; align-items: center; overflow-wrap: break-word !important;"><section style="max-width: 100%; display: flex; justify-content: center; align-items: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section data-num="3" style="max-width: 100%; box-sizing: border-box; width: 45px; height: 45px; background: rgb(237, 245, 255); line-height: 45px; color: rgb(11, 121, 255); border-radius: 100%; font-size: 18px; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">4</strong></section><section style="margin-left: -10px; max-width: 100%; box-sizing: border-box; width: 80px; height: 25px; background: rgb(237, 245, 255); overflow: hidden; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section></section><section data-brushtype="text" style="margin-left: -60px; max-width: 100%; font-size: 16px; letter-spacing: 1.5px; color: rgb(11, 121, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">减少术中知晓发生的策略</strong></section></section><section style="margin-top: -5px; max-width: 100%; display: flex; justify-content: flex-end; align-items: flex-start; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section data-width="38%" style="max-width: 100%; box-sizing: border-box; width: 97.8438px; height: 2px; background: rgb(11, 121, 255); overflow: hidden; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section></section></section></section></section><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">(</strong>1)术前评估</font></strong></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">&nbsp;&nbsp;&nbsp;&nbsp;在术前访视患者时,依据上述术中知晓的可能危险因素,从病史、麻醉史、手术类型和麻醉管理等方面进行分析判断高危人群。如果患者具有术中知晓的危险因素:</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">①告知患者发生术中知晓的可能性;</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">②术前预防性使用苯二氮䓬类药物,如咪达唑仑。&nbsp;</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">&nbsp;&nbsp;&nbsp;&nbsp;</p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; max-inline-size: 100%; cursor: text; box-sizing: border-box !important; overflow-wrap: break-word !important; outline: none 0px !important;"><font color="#cc0000">推荐意见5</font></strong><font color="#333333">:在实施全身麻醉前,麻醉科医师对每位患者评估术中知晓的危险因素,对高危人群告知术中发生知晓的风险(C级)。</font></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; max-inline-size: 100%; cursor: text; box-sizing: border-box !important; overflow-wrap: break-word !important; outline: none 0px !important;"><font color="#cc0000">推荐意见6</font></strong><font color="#333333">:术前预防性使用苯二氮䓬类药物能够减少术中知晓的发生率,但苯二氮䓬类药物的使用可能导致部分患者苏醒延迟和术后谵妄(B级)。</font></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">(</strong>2)术中麻醉管理</font></strong></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">①检查麻醉设备,减少失误,特别是吸入麻醉药是否有泄漏等;</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">②预防性使用苯二氮䓬类药物,包括术前和浅麻醉时应用;预防性使用胆碱能受体拮抗剂(如长托宁),可能有一定作用;</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">③有术中知晓危险时,如发生气管插管困难时,应追加镇静药;</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">④单纯血液动力学数据并非判断麻醉深度的指标;</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">⑤肌松药可掩盖麻醉科医师对麻醉深度的判定;</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">⑥监测呼气末吸入麻醉药浓度,维持年龄校正后的呼气末浓度>0.7MAC;</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">⑦提倡使用基于脑电图信号分析的麻醉深度监测手段,避免麻醉过浅或过深;</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">⑧减少术中对患者的不必要刺激(声、光)。耳塞的使用可能有预防术中知晓的作用;</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">⑨麻醉科医师对使用过β受体阻滞剂、钙通道阻滞剂及掩盖麻醉状态所导致生理反应药物保持警惕;</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">⑩所有手术室人员避免不恰当的说笑、讨论其他患者或不相关的话语。</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">(</strong>3)术后处理</font></strong></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">&nbsp;&nbsp;&nbsp;&nbsp;术后处理包括分析患者的知晓报告,向质控部门汇报,为患者提供适当的术后随访和相应治疗。</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">&nbsp;&nbsp;&nbsp;</p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; max-inline-size: 100%; cursor: text; box-sizing: border-box !important; overflow-wrap: break-word !important; outline: none 0px !important;"><font color="#cc0000">推荐意见7</font></strong><font color="#333333">:采取上述多模式措施,以切实降低术中知晓的发生率。</font></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><section data-tools="135编辑器" data-id="99660" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 10px auto; max-width: 100%; text-align: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="max-width: 100%; display: inline-block; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="padding-right: 10px; max-width: 100%; box-sizing: border-box; display: flex; justify-content: center; align-items: center; overflow-wrap: break-word !important;"><section style="max-width: 100%; display: flex; justify-content: center; align-items: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section data-num="4" style="max-width: 100%; box-sizing: border-box; width: 45px; height: 45px; background: rgb(237, 245, 255); line-height: 45px; color: rgb(11, 121, 255); border-radius: 100%; font-size: 18px; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">5</strong></section><section style="margin-left: -10px; max-width: 100%; box-sizing: border-box; width: 80px; height: 25px; background: rgb(237, 245, 255); overflow: hidden; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section></section><section data-brushtype="text" style="margin-left: -60px; max-width: 100%; font-size: 16px; letter-spacing: 1.5px; color: rgb(11, 121, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">脑电监测的定义和种类</strong></section></section><section style="margin-top: -5px; max-width: 100%; display: flex; justify-content: flex-end; align-items: flex-start; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section data-width="38%" style="max-width: 100%; box-sizing: border-box; width: 91.1875px; height: 2px; background: rgb(11, 121, 255); overflow: hidden; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section></section></section></section></section><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; caret-color: red; font-family: 黑体, SimHei; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></font></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">(</strong>1)睡眠或麻醉时脑电活动同步变化</font></strong></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; font-family: 宋体; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><font color="#333333">目前,术中知晓的发生机制尚未明确。在ASA已结案的索赔医疗纠纷中,大多数发生术中知晓的病例并没有麻醉偏浅的征象。因此,认为预防术中知晓只需简单加深麻醉就能够解决的观点显然是片面的。此外,近年研究表明麻醉过深可能与患者远期病残率和死亡率有关。</font></section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br></section><section data-role="paragraph" style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#333333">脑电图(EEG)反映的脑皮质神经细胞电活动,已被证实与睡眠或麻醉深度直接相关,即睡眠或麻醉时脑电活动同步变化。随着全麻深度增加,脑电呈现慢波特征(频率逐渐减慢,同时波幅增大),再至爆发抑制,最终呈等电位线。因此,基于EEG信号的分析技术已广泛用于围术期麻醉深度监测。</font><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; font-family: 宋体; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; font-family: 宋体; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></font></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; font-family: 宋体; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000" style=""><strong>(2)临床使用的监测麻醉深度的脑电分析仪</strong><strong></strong></font></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; font-family: 宋体; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; font-family: 宋体; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><font color="#333333">①脑电双频谱指数(bispectral index, BIS)监测仪</font></section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">②熵(Entropy)模型</section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">③Narcotrend监测仪</section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">④NeuroSENSE监测仪</section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">⑤Conview监测仪</section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">⑥SEDline监测仪</section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">⑦SNAPII监测仪</section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">⑧qCON 2000监测仪</section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">⑨BOSpro和NOX监测仪</section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br></section><section data-role="paragraph" style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#333333">上述监测设备都基于脑电信号处理(processed EEG, pEEG),采用不同的时域分析、频域分析和/或爆发抑制数据推导出相关指数,量化患者的麻醉深度。</font><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; font-family: 宋体; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; font-family: 宋体; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; font-family: 宋体; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></strong></strong></p><font color="#cc0000"><strong style="">(</strong><strong style="">3)常用监测指标</strong></font></section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br></section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br></section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">①脑电功率谱</section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">②爆发抑制率(BS)</section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">③脑电双频谱指数(BIS)</section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">④反应熵(Response entropy, RE)</section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">⑤状态熵(State entropy, SE)</section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">⑥Narcotrend指数</section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">⑦WAVcns指数</section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">⑧患者状态指数(Patient state index, PSI)</section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">⑨SNAP指数</section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">⑩Ai麻醉深度指数</section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br></section><section data-role="paragraph" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">听觉是全麻诱导过程中最晚消失和最早恢复的感觉,可采用听觉诱发电位(Auditory evoked potential, AEP)来反映麻醉和觉醒状态。</section><section data-role="paragraph" style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; font-family: 宋体; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; font-family: 宋体; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><section data-tools="135编辑器" data-id="99660" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 10px auto; max-width: 100%; text-align: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="max-width: 100%; display: inline-block; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="padding-right: 10px; max-width: 100%; box-sizing: border-box; display: flex; justify-content: center; align-items: center; overflow-wrap: break-word !important;"><section style="max-width: 100%; display: flex; justify-content: center; align-items: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section data-num="5" style="max-width: 100%; box-sizing: border-box; width: 45px; height: 45px; background: rgb(237, 245, 255); line-height: 45px; color: rgb(11, 121, 255); border-radius: 100%; font-size: 18px; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">6</strong></section><section style="margin-left: -10px; max-width: 100%; box-sizing: border-box; width: 80px; height: 25px; background: rgb(237, 245, 255); overflow: hidden; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section></section><section data-brushtype="text" style="margin-left: -60px; max-width: 100%; font-size: 16px; letter-spacing: 1.5px; color: rgb(11, 121, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">脑电监测的临床应用</strong></section></section><section style="margin-top: -5px; max-width: 100%; display: flex; justify-content: flex-end; align-items: flex-start; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section data-width="38%" style="max-width: 100%; box-sizing: border-box; width: 84.5469px; height: 2px; background: rgb(11, 121, 255); overflow: hidden; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section></section></section></section></section><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">&nbsp;<br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; font-family: 宋体; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><font color="#333333">自1990年以来,脑电监测仪被相继开发并投入临床应用,以降低术中知晓风险。随着全麻术中脑电监测的推广,研究人员发现深麻醉可能与术后远期病残率和死亡率等相关。目前,基于脑电分析的麻醉深度监测仪主要应用如下。</font><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; font-family: 宋体; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; font-family: 宋体; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000" style=""><strong>(1)预防术中知晓</strong></font></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; font-family: 宋体; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; font-family: 宋体; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><font color="#333333">研究证实,BIS监测对接受全凭静脉麻醉的患者可降低术中知晓的发生率;对血流动力学不稳定的患者,BIS监测也能降低此类患者术中知晓的风险。然而,对接受吸入麻醉的患者,维持年龄校正后呼气末麻醉药浓度>0.7MAC与BIS<60在减少术中知晓方面无差异。目前,仍缺乏预防术中知晓高度敏感性和特异性的脑电监测仪。需要认真关注手术过程,熟悉手术进度,当手术进入明显伤害刺激期间,必须保证麻醉深度。&nbsp;</font><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; max-inline-size: 100%; cursor: text; box-sizing: border-box !important; overflow-wrap: break-word !important; outline: none 0px !important;"><font color="#cc0000">推荐意见8</font></strong><font color="#333333">:目前仍缺乏高度敏感性和特异性的脑电监测仪。不建议将脑电监测常规用于所有全身麻醉的患者以预防术中知晓的发生,应当根据每个患者的特殊情况来确定是否需要术中使用脑电监测仪(B级)。</font></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; max-inline-size: 100%; cursor: text; box-sizing: border-box !important; overflow-wrap: break-word !important; outline: none 0px !important;"><font color="#cc0000">推荐意见9</font></strong><font color="#333333">:对接受全凭静脉麻醉的患者或血流动力学不稳定的患者,基于脑电信号的麻醉深度监测可降低其术中知晓的发生率(A级)。</font></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000"><strong style="max-width: 100%; max-inline-size: 100%; cursor: text; box-sizing: border-box !important; overflow-wrap: break-word !important; outline: none 0px !important;">推荐意见</strong><strong style="max-width: 100%; max-inline-size: 100%; cursor: text; box-sizing: border-box !important; overflow-wrap: break-word !important; outline: none 0px !important;">10</strong></font><font color="#333333">:对接受吸入麻醉的患者,年龄校正后呼气末麻醉药浓度>0.7MAC与BIS<60在减少术中知晓方面无差异(A级)。</font></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">(</strong>2)监测麻醉深度</font></strong></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">研究显示,在全麻期间使用脑电监测仪可能避免麻醉过深导致的不良后果,如苏醒延迟、术后谵妄和认知问题、甚至死亡。但是,以BIS值作为全麻深度的唯一客观指标本身存在着局限性。高危患者对麻醉药的敏感性比健康患者更高,对其采用脑电监测仪监测麻醉(镇静)深度,可避免过度抑制。欧洲麻醉学会(ESA)建议将术中脑电监测用于老年患者,避免麻醉过深导致的脑电爆发抑制,以减少术后谵妄。但是,以BIS值作为全麻深度的唯一客观指标本身存在着局限性。</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; max-inline-size: 100%; cursor: text; box-sizing: border-box !important; overflow-wrap: break-word !important; outline: none 0px !important;"><font color="#cc0000">推荐意见11</font></strong><font color="#333333">:全麻深度与术后谵妄发生的关系尚待进一步研究,以BIS值为指标的全麻深度监测并不能够确预测术后谵妄的发生(B级)。</font></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000"><strong style="max-width: 100%; max-inline-size: 100%; cursor: text; box-sizing: border-box !important; overflow-wrap: break-word !important; outline: none 0px !important;">推荐</strong><strong style="max-width: 100%; max-inline-size: 100%; cursor: text; box-sizing: border-box !important; overflow-wrap: break-word !important; outline: none 0px !important;">意见12</strong></font><font color="#333333">:吸入全麻状态下,BIS数值高低与手术患者一年内的死亡率无关。高危患者对麻醉药的敏感性比健康患者更高,对高危患者采用脑电监测仪监测麻醉深度的必要性增加(A级)。</font></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><section data-tools="135编辑器" data-id="99660" style="color: rgb(51, 51, 51); max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 10px auto; max-width: 100%; text-align: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="max-width: 100%; display: inline-block; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="padding-right: 10px; max-width: 100%; box-sizing: border-box; display: flex; justify-content: center; align-items: center; overflow-wrap: break-word !important;"><section style="max-width: 100%; display: flex; justify-content: center; align-items: center; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section data-num="6" style="max-width: 100%; box-sizing: border-box; width: 45px; height: 45px; background: rgb(237, 245, 255); line-height: 45px; color: rgb(11, 121, 255); border-radius: 100%; font-size: 18px; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">7</strong></section><section style="margin-left: -10px; max-width: 100%; box-sizing: border-box; width: 80px; height: 25px; background: rgb(237, 245, 255); overflow: hidden; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section></section><section data-brushtype="text" style="margin-left: -60px; max-width: 100%; font-size: 16px; letter-spacing: 1.5px; color: rgb(11, 121, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">脑电监测的局限性</strong></section></section><section style="margin-top: -5px; max-width: 100%; display: flex; justify-content: flex-end; align-items: flex-start; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section data-width="38%" style="max-width: 100%; box-sizing: border-box; width: 77.8906px; height: 2px; background: rgb(11, 121, 255); overflow: hidden; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section></section></section></section></section><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">目前,所有脑电监测仪都依赖于原始EEG信号的复杂数学算法来推导出相应的指数用于指导临床。这些脑电信号均来自于患者额部或颞部脑区,导致其在空间分辨率和评估脑功能的区域关联性方面存在较大局限性,无法使用统一标准的EEG特征来准确判断所有患者的麻醉状态/深度。此外,许多因素可通过影响EEG信号干扰其作为麻醉深度指标的可靠性,具体如下:</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">(</strong>1)患者因素</font></strong></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">现有脑电监测仪的数据都来源于健康志愿者。因此,阿尔兹海默症、血管性痴呆、脑缺血等患者表现出异常EEG,可导致脑电监测指标异常。此外,高龄、低体温、低血糖、酸碱平衡异常也会干扰EEG和相应指数。</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">(</strong>2)麻醉药物</font></strong></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">不同麻醉药物对EEG影响亦有所不同。如小剂量氯胺酮可增强高频EEG活动,导致BIS指数增加。</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">(</strong>3)肌松药物</font></strong></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">在无肌松状态下,头皮产生的电活动可干扰EEG,导致BIS监测仪无法区分肌电信号(EMG)和高频EEG活动。</p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br></p><p style="margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><font color="#cc0000"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">(</strong>4)其他</font></strong></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br></strong></p><p style="color: rgb(51, 51, 51); margin-bottom: 0px; max-width: 100%; clear: both; min-height: 1em; line-height: 25.5px; box-sizing: border-box !important; overflow-wrap: break-word !important;">术中电凝器、心脏起搏器等都可影响脑电监测的可靠性。</p></section></section></section></section></section>

脑电监测应用

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