脑电双频指数在单椎板入路选择性神经后根离断术中的应用  

Application of bispectral index during single-level selective dorsal rhizotomy

作　　者：王国庆 王君璐[1,3] 蒋文彬 刘珺珺 Wang Guoqing;Wang Junlu;Jiang Wenbin;Liu Junjun(Department of Anesthesiology,Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200062,China;Department of Neurosurgery,Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]上海市儿童医院,上海200062 [2]上海交通大学医学院附属儿童医院麻醉科,上海200062 [3]上海交通大学医学院附属儿童医院神经外科

出　　处：《临床小儿外科杂志》2022年第10期947-952,共6页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨脑电双频指数(bispectral index,BIS)在儿童单椎板入路选择性神经后根离断术(single-level selective dorsal rhizotomy,SL-SDR)中的应用价值。方法回顾性分析2019年3月至2022年3月在上海市儿童医院行SL-SDR手术、且全程进行BIS监测的痉挛型脑瘫患儿临床资料。根据术中神经电生理监测期间是否发生肌电干扰,将患儿列入肌电干扰组(D组)和无肌电干扰组(N组),收集两组患儿性别、年龄、体重、脑瘫类型、术前粗大运动功能分级、静脉麻醉维持方案以及药物剂量、神经根阈值比等;同时收集D组患儿自神经电生理刺激开始至首次出现肌电干扰期间的BIS值和N组患儿自神经电生理刺激开始至刺激结束期间的BIS值,并进行对比分析。结果本研究共纳入43例SL-SDR患儿,其中D组22例,N组21例。两组一般情况、脑瘫类型、粗大运动功能分级、麻醉方案及剂量、阈值比等方面比较,差异均无统计学意义(P>0.05)。D组BIS值(53.4±7.2)明显高于N组(46.1±9.4),差异有统计学意义(t=11.889,P=0.007)。Logistic回归分析结果显示,SL-SDR术中神经电生理监测期间的BIS值是发生肌电干扰的独立风险因素[OR值=1.154、95%CI(1.035~1.287),P=0.01]。结论SL-SDR术中神经电生理监测期间BIS值是发生肌电干扰的独立风险因素,BIS值≥51可作为预测发生肌电干扰的指标。Objective To summarize the application of bispectral index(BIS)during single-level selective dorsal rhizotomy(SL-SDR)for children with cerebral palsy(CP).Methods From March 2019 to March 2022,retrospective review was performed for 43 CP children undergoing SL-SDR.BIS was monitored during SL-SDR.They were divided into two groups of D(disturbance)and N(normal)according to the presence or absence of electromyographic disturbance.Gender,age,weight,type of CP,gross motor function classification system,mode of intravenous anesthesia,drug dose and dorsal root threshold ratio were recorded.At the same time,BIS values of group D from the beginning of electrophysiological stimulation to initial occurrence of electromyographic disturbance and group N from the beginning to the end of electrophysiological stimulation were compared.Results There were electromyographic disturbance(n=22)and non-disturbance(n=21).No significant inter-group differences existed in demographic characteristic,type of cerebral palsy,gross motor function classification system,anesthesia mode dosage or threshold ratio(P>0.05).The mean BIS value of group D(53.4±7.2)was significantly higher than that of group N(46.1±9.4)(t=11.889,P=0.007).According to the results of Logistic regression analysis,BIS value was an independent risk factor for electromyography disturbance in SL-SDR during intraoperative neurophysiological monitoring[OR=1.154,5%CI(1.035-1.287),P=0.01].Conclusion During SL-SDR neurophysiological monitoring,BIS value is an independent risk factor for electromyographic disturbance.And BIS≥51 may be employed as an indicator for predicting the occurrence of electromyographic disturbance.

关 键 词：脑电双频指数 脑性瘫痪 轻截瘫 痉挛性 脊神经根切断术 神经电生理监测 

分 类 号：R72[医药卫生—儿科]