CAJ | 학술논문

目的评价BIS值监测患儿七氟醚复合氧化亚氮(N2O)麻醉深度的准确性.方法择期拟在全麻下行腹部手术患儿72例,年龄1～14岁,ASA分级Ⅰ或Ⅱ级,按年龄分层后随机分为3组(n=24):七氟醚组(S组)、七氟醚+30% N2O组(SN1组)和七氟醚+60% N2O组(SN2组).静脉注射阿托品、利多卡因、异丙酚、罗库溴铵和瑞芬太尼麻醉诱导,气管插管后行机械通气,维持PET CO2 35～45 mm Hg;吸入2.5%七氟醚维持麻醉,SN1组和SN2组分别复合吸入30%和60%N2O.手术开始时调节七氟醚吸入浓度,使七氟醚呼气末浓度(CETSev)分别达到2.5%、2.0%和1.5%,每个CETSev维持10 min视为稳态;此后调节七氟醚吸入浓度,维持BIS值40～60.于麻醉诱导前和CETSev达稳态时记录BIS值;于BIS值40～60维持20 min时记录CETSev(C50).结果与S组比较,SN1组BIS值和C50差异无统计学意义(P＞0.05);与S组及SN1组比较,SN2组BIS值和C50降低(P＜0.05);S组、SN1组和SN2组BIS值与CETSev间的相关系数分别为-0.736、-0.817和-0.729(P＜0.01),三组相关系数比较差异无统计学意义(P＞0.05).结论 BIS值可准确地监测患儿吸人七氟醚复合N2O时的麻醉深度.
목적 평개BIS치감측환인칠불미복합양화아담(N2O)마취심도적준학성.방법 택기의재전마하행복부수술환인72례,년령1～14세,ASA분급Ⅰ혹Ⅱ급,안년령분층후수궤분위3조(n=24):칠불미조(S조)、칠불미+30% N2O조(SN1조)화칠불미+60% N2O조(SN2조).정맥주사아탁품、리다잡인、이병분、라고추안화서분태니마취유도,기관삽관후행궤계통기,유지PET CO2 35～45 mm Hg;흡입2.5%칠불미유지마취,SN1조화SN2조분별복합흡입30%화60%N2O.수술개시시조절칠불미흡입농도,사칠불미호기말농도(CETSev)분별체도2.5%、2.0%화1.5%,매개CETSev유지10 min시위은태;차후조절칠불미흡입농도,유지BIS치40～60.우마취유도전화CETSev체은태시기록BIS치;우BIS치40～60유지20 min시기록CETSev(C50).결과 여S조비교,SN1조BIS치화C50차이무통계학의의(P＞0.05);여S조급SN1조비교,SN2조BIS치화C50강저(P＜0.05);S조、SN1조화SN2조BIS치여CETSev간적상관계수분별위-0.736、-0.817화-0.729(P＜0.01),삼조상관계수비교차이무통계학의의(P＞0.05).결론 BIS치가준학지감측환인흡인칠불미복합N2O시적마취심도.
Objective To evaluate the accuracy of BIS value for monitoring the depth of sevoflurane-nitrous oxide in children. Methods Seventy-two ASA Ⅰ or Ⅱ children aged 1-14 yr undergoing abdominal surgery were randomly assigned into 3 groups ( n = 24 each) :sevoflurane group (group S), sevoflurane + 30% N2O group (group SN1 )and sevoflurane + 60% N2O (group SN2 ). Anesthesia was induced with atropine, lidocaine, propofol, rocuronium and remifentanil. After tracheal intubation, the patients were mechanically ventilated. PETCO2 was maintained at 35-45 mm Hg. Anesthesia was maintained with 2.5% sevoflurane combined with 0, 30% and 60% nitrous oxide in group S, SN1 and SN2 respectively. The end-tidal sevoflurane concentration (CETSev) was maintained at 2.5%, 2.0% and 1.5%. Each CETSev was maintained for at least 10 min after the begining of the surgery. Then the CETSev was modified to maintain BIS value at 40-60. BIS value was recorded before anesthesia induction and each stable CETSev. CETSev was recorded at maintaining BIS value of 40-60 for at least 20 min ( C50 ).Results BIS value and C50 were significantly lower in group SN2 than in group S and SN1 ( P ＜ 0.05), while no significant difference was found between group S and SN1 ( P ＞ 0.05). BIS value was negatively correlated with CETSev in all 3 groups (r = -0.736, -0.817, -0.729, P ＜ 0.01).There was no significant difference in the correlation coefficients among the 3 groups ( P ＞ 0.05 ). Conclusion BIS value can accurately reflect the depth of sevoflurane-nitrous oxide anesthesia in children.