中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2009年
10期
908-910
,共3页
脑电描记术%监测%手术中%儿童%七氟醚
腦電描記術%鑑測%手術中%兒童%七氟醚
뇌전묘기술%감측%수술중%인동%칠불미
Electroencephalography%Monitoring%intraoperative%Child%Sevoflurane
目的 探讨脑电双频谱指数(BIS)用于不同年龄患儿吸入七氟醚麻醉深度监测的准确性.方法 择期拟行腹部手术患儿105例,ASAⅠ或Ⅱ级,年龄新生儿～14岁,根据不同年龄段分为3组(n=35):年长儿组(4～14岁,Ⅰ组)、幼儿组(1～3岁,Ⅱ组)和婴儿组(<1岁,Ⅲ组),所有患儿吸入5%七氟醚,以6 L/min氧流量(高流量)洗入,意识消失后静脉注射罗库溴铵0.6 mg/kg,气管插管后机械通气.以0.2%～0.4%布比卡因2 mg/kg行硬膜外阻滞,1岁以下患儿行骶管阻滞.手术开始时氧流量调至3 L/min,调节七氟醚挥发罐刻度,使6个月以下患儿呼气末七氟醚浓度(C_(ET)Sev)分别为3.2%、2.6%、1.9%、1.4%,6个月以上患儿C_(ET)Sev分别为2.5%、2.0%、1.5%、1.0%,每个浓度维持至少15 min视为达到稳态.于麻醉诱导前即刻(T_1)、气管插管前即刻(T_2)、气管插管后即刻(T_3)、C_(ET)Sev达稳态时(T_(4～7))、咽反射恢复时(T_8),拔除气管导管时(T_9)和清醒时(T_10)记录BIS、HR、SP、DP和MAP.结果 与T_1时比较,Ⅰ组和Ⅱ组T_(2～9)时BIS降低,Ⅲ组T_(2～10)时BIS降低(P<0.05),3组血液动力学指标均在临床允许范围内.与Ⅰ组比较,Ⅱ组T_(4,6,7)时BIS升高,Ⅲ组T,<5～9>时BIS降低(P<0.05);与Ⅱ组比较,Ⅲ组T_(3～10)时BIS降低(P<0.05).Ⅰ组、Ⅱ组和Ⅲ组B1S与C_(ET)Sev的相关系数分别为-0.768、-0.709、-0.357,Ⅰ组和Ⅱ组的相关程度高于Ⅲ组(P<0.01).结论 1岁以上患儿BIS可准确监测吸入七氟醚麻醉深度,小于1岁患儿BIS监测吸入七氟醚麻醉深度准确性较低.
目的 探討腦電雙頻譜指數(BIS)用于不同年齡患兒吸入七氟醚痳醉深度鑑測的準確性.方法 擇期擬行腹部手術患兒105例,ASAⅠ或Ⅱ級,年齡新生兒～14歲,根據不同年齡段分為3組(n=35):年長兒組(4～14歲,Ⅰ組)、幼兒組(1～3歲,Ⅱ組)和嬰兒組(<1歲,Ⅲ組),所有患兒吸入5%七氟醚,以6 L/min氧流量(高流量)洗入,意識消失後靜脈註射囉庫溴銨0.6 mg/kg,氣管插管後機械通氣.以0.2%～0.4%佈比卡因2 mg/kg行硬膜外阻滯,1歲以下患兒行骶管阻滯.手術開始時氧流量調至3 L/min,調節七氟醚揮髮罐刻度,使6箇月以下患兒呼氣末七氟醚濃度(C_(ET)Sev)分彆為3.2%、2.6%、1.9%、1.4%,6箇月以上患兒C_(ET)Sev分彆為2.5%、2.0%、1.5%、1.0%,每箇濃度維持至少15 min視為達到穩態.于痳醉誘導前即刻(T_1)、氣管插管前即刻(T_2)、氣管插管後即刻(T_3)、C_(ET)Sev達穩態時(T_(4～7))、嚥反射恢複時(T_8),拔除氣管導管時(T_9)和清醒時(T_10)記錄BIS、HR、SP、DP和MAP.結果 與T_1時比較,Ⅰ組和Ⅱ組T_(2～9)時BIS降低,Ⅲ組T_(2～10)時BIS降低(P<0.05),3組血液動力學指標均在臨床允許範圍內.與Ⅰ組比較,Ⅱ組T_(4,6,7)時BIS升高,Ⅲ組T,<5～9>時BIS降低(P<0.05);與Ⅱ組比較,Ⅲ組T_(3～10)時BIS降低(P<0.05).Ⅰ組、Ⅱ組和Ⅲ組B1S與C_(ET)Sev的相關繫數分彆為-0.768、-0.709、-0.357,Ⅰ組和Ⅱ組的相關程度高于Ⅲ組(P<0.01).結論 1歲以上患兒BIS可準確鑑測吸入七氟醚痳醉深度,小于1歲患兒BIS鑑測吸入七氟醚痳醉深度準確性較低.
목적 탐토뇌전쌍빈보지수(BIS)용우불동년령환인흡입칠불미마취심도감측적준학성.방법 택기의행복부수술환인105례,ASAⅠ혹Ⅱ급,년령신생인～14세,근거불동년령단분위3조(n=35):년장인조(4～14세,Ⅰ조)、유인조(1～3세,Ⅱ조)화영인조(<1세,Ⅲ조),소유환인흡입5%칠불미,이6 L/min양류량(고류량)세입,의식소실후정맥주사라고추안0.6 mg/kg,기관삽관후궤계통기.이0.2%～0.4%포비잡인2 mg/kg행경막외조체,1세이하환인행저관조체.수술개시시양류량조지3 L/min,조절칠불미휘발관각도,사6개월이하환인호기말칠불미농도(C_(ET)Sev)분별위3.2%、2.6%、1.9%、1.4%,6개월이상환인C_(ET)Sev분별위2.5%、2.0%、1.5%、1.0%,매개농도유지지소15 min시위체도은태.우마취유도전즉각(T_1)、기관삽관전즉각(T_2)、기관삽관후즉각(T_3)、C_(ET)Sev체은태시(T_(4～7))、인반사회복시(T_8),발제기관도관시(T_9)화청성시(T_10)기록BIS、HR、SP、DP화MAP.결과 여T_1시비교,Ⅰ조화Ⅱ조T_(2～9)시BIS강저,Ⅲ조T_(2～10)시BIS강저(P<0.05),3조혈액동역학지표균재림상윤허범위내.여Ⅰ조비교,Ⅱ조T_(4,6,7)시BIS승고,Ⅲ조T,<5～9>시BIS강저(P<0.05);여Ⅱ조비교,Ⅲ조T_(3～10)시BIS강저(P<0.05).Ⅰ조、Ⅱ조화Ⅲ조B1S여C_(ET)Sev적상관계수분별위-0.768、-0.709、-0.357,Ⅰ조화Ⅱ조적상관정도고우Ⅲ조(P<0.01).결론 1세이상환인BIS가준학감측흡입칠불미마취심도,소우1세환인BIS감측흡입칠불미마취심도준학성교저.
Objective To evaluate the accuracy of bispectral index (BIS) for monitoring the depth of sevoflurane anesthesia in children of different ages.Methods One hundred and five children (0-14 yr) undergoing abdominal surgery were divided into 3 age groups (n=35 each): group Ⅰ 4-14 yr (older children); group Ⅱ 1-3 yr (young children) and group Ⅲ < 1 yr (infants). All of the patients were anesthetized with sevoflurane combined with epidural or caudal blockade. Anesthesia was induced with 5 % sevoflurane in O_2. After tracheal intubation, the patients were mechanically ventilated. P_(ET) CO_2 was maintained at 35-45 mm Hg. The end-tidal sevoflurane concentration (C_(ET)Sev) Was maintained at 3.2%, 2.6%, 1.9% and 1.4% in infants < 6 months andat 2.5%, 2.0%, 1.5% and 1.0% in children > 6 months. Each C_(ET)Sev was maintained for at least 15 min. MAP, HR, P_(ET)CO_2 and BIS were monitored and recorded before anesthesia (T_1, baseline), at loss of consciousness (T_2), immediately after tracheal intuhation (T_3), at the 4 C_(ET)Sev (T_(4-7)), recovery of pharyngeal reflex (T_8), extubation (T_9) and emergence of anesthesia (T_10). Results BIS values were significantly higher in children of 1-3 yr (group Ⅱ) than in children of 3-14 yr (group Ⅰ) at T_(4,6,7). BIS values were significantly lower in infants (group Ⅲ) than in children of 3-14 yr (group Ⅰ) at T_(5-9). BIS values were significantly lower in infants (group Ⅲ) than in children of 1-3 yr (groupⅡ) at T_(3-10). There was significant negative correlation between BIS and C_(ET)Sev in all 3groups(γ=-0.768,-0.709,-0.357).Conclusion BIS can accurately reflect the depth of sevoflurane anesthesia in children (> 1 yr). BIS should be interpreted cautiously in infants (< 1 yr).
