CAJ | 학술논문

目的观察七氟烷和靶控输注普鲁泊福对小儿斜视手术眼心反射发生的影响.方法全麻下择期行斜视手术患儿138例,ASA分级Ⅰ～Ⅱ级,按照随机数字表法分为六组,七氟烷吸入组(S_1、S_2、S_3组)和普鲁泊福靶控输注组(P_1、P_2、P_3组),每组各23例.预先设定术中维持不同的脑电双频指数(BIS):S_1、P_1组BIS为60,S_2、P_2组BIS为50,S_3、P_3组BIS为40.术中均静脉微泵输注瑞芬太尼[速度1.2 μg/(kg·min)],根据设定的BIS调整普鲁泊福靶控输注浓度或七氟烷浓度.记录麻醉前,术中牵拉眼肌时的心率、BIS、眼心反射发生情况及普鲁泊福靶控输注浓度或七氟烷浓度.结果 P_1、P_2、P_2、S_1、S_2、S_3组眼心反射发生率分别为73.9%(17/23)、39.1%(9/23)、17.4%(4,23)、56.5%(13/23)、26.1%(6/23)、8.7%(2/23),P_2组和P_3组低于P_1组,S_2组和S_3组低于S_1组,P_3组、S_3组、S_2组、P_2组低于S_1组和P_1组,S_1组低于P_1组、S_2组低于P_2组、S_3组低于P_3组,差异均有统计学意义(P<0.05).普鲁泊福靶控输注浓度P_2组[(4.3±0.2)mg/L]和P_3组[(5.5±0.1)mg,L]高于P_1组[(3.2±0.1)mg/L](P<0.05);七氟烷浓度S_2组[(1.8±0.3)%]和S_3组[(2.3±0.2)%]高于S_1组[(1.3±0.2)%](P<0.05).结论 BIS在40～50时对预防眼心反射有重要意义.相同BIS时,吸入七氟烷眼心反射发生率较靶控输注普鲁泊福低.
목적 관찰칠불완화파공수주보로박복대소인사시수술안심반사발생적영향.방법 전마하택기행사시수술환인138례,ASA분급Ⅰ～Ⅱ급,안조수궤수자표법분위륙조,칠불완흡입조(S_1、S_2、S_3조)화보로박복파공수주조(P_1、P_2、P_3조),매조각23례.예선설정술중유지불동적뇌전쌍빈지수(BIS):S_1、P_1조BIS위60,S_2、P_2조BIS위50,S_3、P_3조BIS위40.술중균정맥미빙수주서분태니[속도1.2 μg/(kg·min)],근거설정적BIS조정보로박복파공수주농도혹칠불완농도.기록마취전,술중견랍안기시적심솔、BIS、안심반사발생정황급보로박복파공수주농도혹칠불완농도.결과 P_1、P_2、P_2、S_1、S_2、S_3조안심반사발생솔분별위73.9%(17/23)、39.1%(9/23)、17.4%(4,23)、56.5%(13/23)、26.1%(6/23)、8.7%(2/23),P_2조화P_3조저우P_1조,S_2조화S_3조저우S_1조,P_3조、S_3조、S_2조、P_2조저우S_1조화P_1조,S_1조저우P_1조、S_2조저우P_2조、S_3조저우P_3조,차이균유통계학의의(P<0.05).보로박복파공수주농도P_2조[(4.3±0.2)mg/L]화P_3조[(5.5±0.1)mg,L]고우P_1조[(3.2±0.1)mg/L](P<0.05);칠불완농도S_2조[(1.8±0.3)%]화S_3조[(2.3±0.2)%]고우S_1조[(1.3±0.2)%](P<0.05).결론 BIS재40～50시대예방안심반사유중요의의.상동BIS시,흡입칠불완안심반사발생솔교파공수주보로박복저.
Objective To observe the effect of sevoflurane and target controlled infusion (TCI)propofol on the oculocardiac reflex (OCR) in patients with paediatrie strabismus surgery.Methods One hundred and thirty-eight patients ASA Ⅰ-Ⅱ undergoing strabismus surgery were randomly allocated to six greups(propofol groups:P_1,P_2,P_3 group; sevoflurane groups:S_1,S_2,S_3 group,23 cases for each) according to target bispectral index (BIS) of 60,50 and 40.In propofol groups continuous infusion of propofolremifentanil [0.2μg/(kg·min)] was adjusted towards target BIS value.The sevoflurane-remffentanil [0.2μg/(kg·min) ] concentration with 50% N2O/O2 was adjusted toward target BIS too.The incidence of OCR and the lowest heart rate(HR) and BIS were recorded.Results The incidence of OCR were 73.9%(17/23),39.1%(9/23),17.4%(4/23),56.5%(13/23),26.1%(6/23),8.7%(2/23)in P_1,P_2,P_3,S_1,S_2,S_3 soup,P_2 and P_3 group were lower than P_1 group,S_2 and S_3 soup were lower than S_1 group,P_3,S_3,S_2,P_2 group were lower than S_1 and P_1 soup,S_1 soup was lower than P_1 group,S_2 soup was lower than P_2 group,S_3 group was lower than P_3 group,there was significant difference(P < 0.05 ).The densities of TCI propofol in P_2 and P_3 soup were higher than that in P_1 group [ (4.3 ±0.2),(5.5±0.1 ) mg/L vs (3.2±0.1 ) mg/L ] (P <0.05),and the densities of sevoflurane in S_2 and S_3 group were higher than that in S_1 group [ ( 1.8±0.3 )%,(2.3±0.2 )% vs(1.3±0.2 )% ] (P<0.05 ).The end-tidal concentration was different with difference of BIS too.Conclusions OCR is relevant to the depth of anesthesia.BIS values of 40-50 seem adequate for the inhibition of OCR.The results suggest that BIS may be a valuable tool during propofol-remifentanil or sevoflurane-remifentanil anesthesia for strabismus surgery in children.The incidence of OCR is higher in propofol than in sevoflurane at the same BIS.