,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,PPT,模板下载：, 浩 康,深圳市威浩康医疗器械有限公司,SHENZHEN WELLCARE MEDICAL APPARTUS CO.,LTD,麻醉深度,监护仪介绍,大脑中动脉,Middle cerebral,a.,灰质,白质,大脑中动脉,Middle cerebral,a.,知觉和痛觉是大脑本能的反应，麻醉深度监护仪随着对脑电波理论研究的深入、脑电信号提取能力提高以及计算机运算速度加快在不断发展着。该产品的研发是通过大量的临床数据分析建立数据库与脑电波理论建立关系，确定计算模式进行临床演练，寻找到麻醉术中患者的知觉程度和痛觉敏感程度变化规律.,麻醉深度测试概述,麻醉深度监测,常把手术麻醉中的镇静和镇痛二者混为一谈,镇静,镇痛,手术之前要睡着 镇静过浅 术中知晓 医疗纠纷,手术之后能醒来 镇静过深 认知障碍 影响康复,疼痛分两个层面：认知层面和生物层面,认知层面患者意识存在时，患者对疼痛是由主观感知的；,生物层面当患者意识消失，伤害性刺激对患者只有躯体有所反应，而患者自身对伤害性刺激无法在术后进行提取和复述，全麻手术中镇痛程度是否适度,/,不适度，这种现象是存在的。如何在术中将镇痛程度控制在适度范围内。,麻醉深度算法模式,脑电波有四个基本脑电波形,(波长-波幅-频率),麻醉深度算法模式,一阶差分,脑能量值：脑电波的波幅值称为脑能量值 代表脑部电活动的大小,脑电波基本波形和正常特征参数值,麻醉深度算法模式,麻醉深度算法模式,麻醉深度算法模式,IoC1,计算法模式,Frequency,Ratio 1,频段,1,Burst,Suppression,爆发抑制比,IoC,1,Adaptive,Neuro,Fuzzy,Inference,System,Frequency,Ratio 2,频段,2,Frequency,Ratio 3,频段,3,Frequency,Ratio 4,频段,4,算,法模式-意识指数神经模糊推理系统,2000次/秒(,采样速度,),线性与非线性计算,自适应性神经,模糊推理系统,麻醉深度算法模式,脑电意识指数是在不同的镇静药物浓度下的意识水平，其数据库来自数万例患者临床OAA/S值和RSS值对比，是患者客观意识水平的真实反映，适用于吸入麻醉和静脉镇静药物。,EEG,脑电图,AWAKE,SEDATED,Anaesthetised,Burst-suppression,(ESR),爆发抑制比,3 s,3 s,3 s,30 s,麻醉,镇静,清醒,麻醉深度算法模式,麻醉深度算法模式,99,Awake,清醒,80,Sedation,麻醉过浅,60,Adequate anaesthesia,40,Deep anaesthesia,麻醉过深,0,Isoelectric EEG-coma,IoC,1,Hypnotic effect,镇静药物作用浓度,脑电零电位,昏迷,适度麻醉,IOC,1,评价镇静程度、评价昏迷程度、评价睡眠质量,IoC2,计算法模式,伤害敏感指数神经模糊推理系统,Frequency,Ratio 5,频段,5,IoC,1,IoC,2,Adaptive,Neuro,Fuzzy,Inference,System,Frequency,Ratio 6,频段,6,Frequency,Ratio 7,频段,7,Frequency,Ratio 8,频段,8,Frequency,Ratio 1,频段,1,Adaptive,Neuro,Fuzzy,Inference,System,Frequency,Ratio 2,频段,2,Frequency,Ratio 3,频段,3,Frequency,Ratio 4,频段,4,Burst,Suppression,爆发抑制比,线性与非线性计算,时,比IoC,1,迟1/4秒进行,(-500个样值),Remifentanil plasma concentration of 4 ng/ml,LOW MEAN HIGH,qNOX 60 40 20,Probability,患者镇痛情况,IoC,1,与EMG曲线 IoC,2,曲线,脑电研究与麻醉深度,加瑞芬太尼,Nociception,疼痛伤害刺激敏感指数,有镇痛监测才能实现麻醉深度监护,1.镇静和镇痛监测同时两种都具备才能实现术中的精确麻醉,2.镇静和镇痛都能监测术中出现血压异常可快速准确处置（附案例）,3.失去知觉状态下的镇痛程度监测避免浅麻时的术中知晓,脑电研究与麻醉深度,脑电IoC2,研究与麻醉深度,Validation of the qNOX,(IoC2),pain/nociception index for monitoring loss of response to tetanic stimulation during general anaesthesia.(2013ASA),Jensen EW,Gambus PL,Pineda P,Valencia JF,Jospin M,Borrat X,Struys MMRF,Vereecke H,Introduction,For the last two decades monitoring of the hypnotic level by EEG has been refined and is now an accepted tool in the OR.The assessment of nociception has proven far more complex.The objective of this study was the validation of a new EEG derived pain and nociception index,termed qNOX(IoC2).,Methods,This study was based on data previously published1,including 45 adult female patients,who were scheduled to undergo ambulatory gynecological surgery.,Initially,a propofol effect-site concentrationof 1.5 ug/ml was targeted in the three groups,while remifentanil was targeted 0,2 or 4ng/mlrespectively,.,The qNOX(IoC2)was developed from EEG matched with clinical signs from sedated or anaesthetised patients,.Several frequency ratios were defined and the four with the best prediction probability of response to noxious stimuli were fed into an Adaptive Neuro Funzzy Inference System(ANFIS)Model,where the output was the qNOX(IoC2).,Two versions of the qNOX(IoC2)are presented,qNOX A(IoC2 A)where the index was trained on data recorded during endoscopy and while awake 2,and qNOX B(IoC2 B)where the training set was the one described in the methods using the leave one out method.The qNOX(IoC2)was defined by feeding 4 EEG/EMG frequency bands(5-90 Hz)into an ANFIS model.A combination between qNOX B(IoC2 B)and predicted effect site concentration of remifentanil was also evaluated.In this case a model for each concentration of remifentanil was calculated.The prediction probability and the standard error,Pk(SE)of qNOX A(IoC2 A)and qNOX B(IoC2 B)versus loss of response to tetanic stimulation was calculated.,Results,The results of the Pk analysis are shown in table 1.,Between qNOX A(IoC2 A)and qNOX B(IoC2 B),the qNOX B(IoC2 B)showed the best performance.Adding the Ce remi to the model increased significantly the Pk value.,Discussion,The study shows that the EEG is capable of predicting the loss of response to tetanic stimulation during propofol and remifentanil anaesthesia.,It was expected that qNOX B(IoC2 B)would give the best performance since the training and validation data were from the same protocol.Adding the concentration of Ce remi,which would be possible if the infusion pumps and the EEG monitor was an integrated device,should be studied further.,The qNOX(IoC2)and a previously published drug interactionmodel(NSRI)3 performed equally well in this dataset(pK=0.87)whereas the combination of the qNOX(IoC2)and the remifentanil effect site concentration had a significantly higher pk=0.92.,References,1 Struys MM,Vereecke H,Moerman A,Jensen EW,Verhaeghen D,De Neve N,Dumortier FJ,Mortier EP.Ability of the bispectral index,autoregressive modelling with exogenous input-derived auditory evoked potentials,and,predicted propofol concentrations to measure patient responsiveness during anesthesia with propofol and remifenta