CAJ | 학술논문

目的评价脑电双频谱指数(BIS)监测异丙酚复合瑞芬太尼全麻患儿麻醉深度的准确性.方法择期手术患儿60例,ASA Ⅰ或Ⅱ级,年龄3～8岁,体重14～40kg,随机分为4组(n=15),人室后开放手背静脉,稳定5 min.C组静脉输注0.9%生理盐水0.2 ml·kg-1·h-1;R1组、R2组和R3组分别静脉输注瑞芬太尼0.1、0.3或0.5 μg·kg-1·min-1,瑞芬太尼或生理盐水输注10 min开始靶控输注异丙酚,起始效应室浓度为1 μg/ml,逐渐递增至2、3、4μg/ml.分别于稳定5min、瑞芬太尼静脉输注10min、异丙酚效应室浓度达到l、2、3、4μg/ml稳定1 min及意识消失时记录BIS和警觉,镇静(OAA/S)评分;记录意识消失时间.采用logistic回归法计算意识消失时的BIS50、BIS95和意识消失时异丙酚的EC50、EC95.BIS与OAA/S评分、异丙酚效应室浓度作直线相关分析.结果 C组、R1.组、R2组和R3组BIS与OAA/S评分均呈正相关,r分别为0.89、0.90、0.87、0.82(P<0.05);BIS与异丙酚效应室浓度均呈负相关,r分别为-0.87、-0.90、-0.87、-0.92(P<0.05);与C组比较,其余3组患儿意识消失时异丙酚效应室浓度降低,意识消失时间缩短,R2组和R3组意识消失时BIS升高,BIS50和BIS95升高,异丙酚EC50和EC95降低(P<0.05);与R1组比较,R2组BIS50和BIS95升高,R3组异丙酚EC50和EC95降低(P<0.05).结论瑞芬太尼复合异丙酚麻醉下,采用BIS监测患儿麻醉深度存在一定局限性.
목적 평개뇌전쌍빈보지수(BIS)감측이병분복합서분태니전마환인마취심도적준학성.방법 택기수술환인60례,ASA Ⅰ혹Ⅱ급,년령3～8세,체중14～40kg,수궤분위4조(n=15),인실후개방수배정맥,은정5 min.C조정맥수주0.9%생리염수0.2 ml·kg-1·h-1;R1조、R2조화R3조분별정맥수주서분태니0.1、0.3혹0.5 μg·kg-1·min-1,서분태니혹생리염수수주10 min개시파공수주이병분,기시효응실농도위1 μg/ml,축점체증지2、3、4μg/ml.분별우은정5min、서분태니정맥수주10min、이병분효응실농도체도l、2、3、4μg/ml은정1 min급의식소실시기록BIS화경각,진정(OAA/S)평분;기록의식소실시간.채용logistic회귀법계산의식소실시적BIS50、BIS95화의식소실시이병분적EC50、EC95.BIS여OAA/S평분、이병분효응실농도작직선상관분석.결과 C조、R1.조、R2조화R3조BIS여OAA/S평분균정정상관,r분별위0.89、0.90、0.87、0.82(P<0.05);BIS여이병분효응실농도균정부상관,r분별위-0.87、-0.90、-0.87、-0.92(P<0.05);여C조비교,기여3조환인의식소실시이병분효응실농도강저,의식소실시간축단,R2조화R3조의식소실시BIS승고,BIS50화BIS95승고,이병분EC50화EC95강저(P<0.05);여R1조비교,R2조BIS50화BIS95승고,R3조이병분EC50화EC95강저(P<0.05).결론 서분태니복합이병분마취하,채용BIS감측환인마취심도존재일정국한성.
Objective To evaluate the accuracy of bispectzal index (BIS) in monitoring depth of anesthesia with remifentnil and propofol in children. Methods Sixty ASA Ⅰor Ⅱ children aged 3-8 yr weighing 14-40 kg undergoing elective surgery under general anesthesia were randomly assigned into 4 groups ( n = 15 each):Ⅰ control group (C) and group Ⅱ, Ⅲ, Ⅳremifentanil group 1,2,3 (R1, R2,R3).The patients were unpremedicated. After the children entered operation room, an intravenous infusion was started in a hand vein. After 5 rain stabilization remifentanil infusion was started at 0.1, 0.3 and 0.5μg·kg-1·min-1 in group R1 , R2 and R3 respectively, at 10 rain of remifentanil infusion. TCI of propofol was started. The initial target effect-site concentration was set at 1 μg/ml and then gradually increased to 2, 3 and 4 μg/ml. BIS values and OAA/S scores were recorded at the end of 5 rain stabilization, 10 min of remifentanil infusion, 1 min after target effect-site concentration of propofol reached 1, 2, 3, 4 μg/ml and when the children lost consciousness (LOC). LOC time was also recorded. BIS50, BIS95, ECho and EC95 were calculated using logistic regression. Results The four groups were comparable with respect to demographic data. BIS was positively correlated with OAA/S and negatively correlaled with effect-site concentration of propofol in group C, R1, R2and R3. Propofol effect-site concentration at LOC was significantly lower and LOC time shorter in group Ri, R2 and R3 than in group C. BIS, BIS50, BIS95 at LOC were significantly higher while EC50 and EC95 at LOC lower in group R1 and R2 than in group C. BIS50 and BIS95 were significantly higher in group R2 and EC50 and EC95 lower in group R3 than in group R1 Conclusion BIS has its limitations in monitoring depth of anesthesia with remifentanil and propofol in children.