麻醉深度是对镇静水平、镇痛水平、刺激反应程度等指标的综合反映,而这些指标反映的中枢部位不尽相同,所以麻醉深度监测应该是多指标、多方法综合监测的结果。或许可以将目前已有的监测指标进行加权平均,得出一个能真正反映临床麻醉深度的麻醉深度指数。由于对抗伤害反应的抑制程度的监测尚未解决,迄今为止,临床体征仍是监测临床麻醉深度的基本方法。BIS、AEP index和墒越来越受到关注,是临床麻醉深度监测较理想的新指标,但仍存在很多局限,需进一步研究,不断完善,且熵的临床价值仍需进一步观察。期望用一种监测手段解决麻醉深度的监测、防止术中觉醒在目前还不现实。
理想的麻醉深度监测的标准应满足如下条件:能显示知晓前的浅麻醉阶段;能准确反映麻醉药在体内的浓度;对不同刺激模式,尤其是外科手术刺激敏感;能即时显示结果;能在统一标准下反映所有麻醉药的麻醉深度;且经济、使用方便。目前已有的麻醉深度监测仪显然均没有达到理想标准,但上述这些标准可作为麻醉深度监测今后发展的目标。
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于布为 上海第二医科大学附属瑞金医院麻醉科(200025)
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