Mining the hidden dysrhythmia - can machines get smarter at defining the anaesthetised state?
Mining the hidden dysrhythmia - can machines get smarter at defining the anaesthetised state?
复制标题
挖掘隐藏的心律失常——机器可以更智能地定义麻醉状态吗？
DOI：
10.1111/anae.13314
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发表时间：
2015
期刊：
影响因子：
10.7
通讯作者：
Jiro Kurata
中科院分区：
文献类型：
--
作者：
Kamikubo Y;Tabata T;Sakurai T.;Jiro Kurata
在商业麻醉深度监测仪开始使用来自大脑的电生理参数，如处理的脑电(EEG)和诱发电位之前，我们使用来自几个生理监测仪的多模式信息来评估麻醉和手术应激之间的平衡，这些生理监测仪包括心电图、间接或直接血压、脉搏血氧饱和度、体温、外周神经刺激以及药代动力学假设。此外，我们使用自己的感官来观察皮肤和血液的颜色；触摸并感受身体的温度和是否在出汗；评估外周循环；评估麻醉/麻醉剂的影响；甚至与患者交谈，通过身体运动和术后回忆来确定反应[1，2]。尽管这一评估的主要部分是基于科学逻辑，但其余的部分更像是某种“艺术”。换句话说，这种技术可能会被改称为“模糊逻辑”[3]，它使临床决策能够利用各种生理现象的积极、消极和灰色区域迹象的混合。即使在当今高科技、计算机密集的脑电监测时代，我们仍然经常需要在临床实践中通过整合不同的信息来做出这样的决定。这种技术在现代麻醉管理中仍然是不可或缺的，在现代麻醉管理中，经常使用多种药物试图达到平衡的麻醉状态，包括意识丧失(或健忘)、抗伤害性感觉、静止、抑制应激反应和保存的动态平衡。
Before the inception of commercial depth-of-anaesthesia monitors using electrophysiological parameters from the brain, such as processed electroencephalography(EEG) and evoked potentials, we used to evaluate the balance between anaesthesia and surgical stress using multimodal information derived from several physiological monitors, including the electrocardiogram (ECG), indirect or direct blood pressure, pulse oximetry, body temperature, peripheral nerve stimulation, as well as pharmacokinetic assumptions. In addition, we used our own senses to see the colour of the skin and the blood; to touch the body and feel its temperature and whether it was sweating, and to assess peripheral circulation; to assess the pupils for anaesthetic/narcotic effects; and even to talk to a patient to determine response by body movement and postoperative recall [1, 2]. Although a major part of this evaluation is based on scientific logic, the rest rather belongs to some kind of ‘art’. Put another way, such art might be rephrased as ‘fuzzy logic’[3], which enables clinical decision-making using a mixture of positive, negative, and grey-zone signs of various physiological phenomena. Even in the present era of high-tech, computer-intensive EEG monitoring, we are still routinely required to make such decisions by integrating heterogeneous information during our clinical practice. Such an art remains indispensable in modern anaesthetic management, where multiple drugs are often administered to attempt to attain a balanced anaesthetic state, consisting of unconsciousness (or amnesia), antinociception, immobility, suppression of the stress response, and preserved homeostasis.