中文摘要：

目的 研究熵指数（包括反应熵和状态熵）对异氟烷复合麻醉中切皮体动反应的预测作用并与双频谱指数（BIS）比较。方法 ASAⅡ级择期腹部手术患者20例，按切皮有无体动反应分为体动组（9例）和非体动组（11例）。入室后常规监测，然后静注异丙酚、琥珀胆碱、芬太尼快诱导气管插管，持续吸入异氟烷，维持呼气末异氟烷浓度为1.3MAC，维持10min后开始手术，切皮前不用神经肌肉阻滞剂，如果发生体动，则按10%提高下一个患者异氟烷呼气末浓度，如果不动则按10%降低下一个患者异氟烷呼气末浓度。分别于入室、切皮前60s、30s、切皮后45s、120s对每例患者同时行熵指数和BIS监测。结果 两组患者的熵指数值有显著性差异（P〈0.05），而BIS无显著性差异（P〉0.05）。反应熵和状态熵可以预测切皮体动，其预测概率（Pk）值分别为0.8937和0.8852，BIS不能预测切皮体动，Pk值是0.5919，熵指数和BIS的Pk值之间有显著性差异（P〈0.05），Pk与反应熵和状态熵的Logistic回归方程分别为ln[Pk/（1-Pk）]=32.517-0.481x和ln[Pk/（1-Pk）]=28.728-0.438x。结论 熵指数监测可以预测异氟烷麻醉中的切皮体动反应，值得临床推广应用。

英文摘要：

Objective To investigate if the spectral entropy （including response entropy and state entropy） can predict the body movement as a response to skin incision during isoflurane anaesthesia, and to compare the value of spectral entropy with that of bispectral index （BIS）. Methods Twenty ASA 11 patients undergoing elective abdominal surgery were studied, and they were allocated into move group （9 cases） and non-move group （11 cases） based on whether there was body movement or no body movement during skin incision. Anaesthesia was induced with iv. propofol, succinylcholine and fentanyl. After induction isoflurane was inhaled and end-tidal concentration was maintained at 1. 3 MAC for 10min, then operation was begun without neuromuscular blockers. The isoflurane end tidal concentration was increased by 10 percent if body movement did not oceur or decreased by 10 percent if movement was not detected. Every patient was simultaneously monitored with spectral entropy and BIS. Data were recorded at following time points： baseline values, 60s and 30s before skin incision, and 45s and 120s after skin incision. Results BIS index showed no significant difference between move group and non-move group （ P〉0.05）, while the entropy index showed significant differences between the two groups （ P〈0. 05）. Response entropy and state entropy could predict the movement at skin incision with Pk of 0. 893 7 and 0. 885 2 respectively, but BIS failed with Pk of 0. 591 9. Furthermore, logistic regressive equations of prediction probability and entropy index were calculated with the results of In [Pk/（ 1- Pk ）] = 32. 517-0. 481 x and In [Pk/（1-Pk）]=28. 728-0. 438x, respectively. Conclusion Entropy index can predict body movemem at skin incision during isoflurane anaesthesia, so it deserves preference in clinic.