七氟烷和普鲁泊福对小儿斜视手术眼心反射影响的比较性研究  

Influence of the anesthetic depth on the inhibition of the oculocardiac reflex compare sevoflurane with target controlled infusion propofol anesthesia for paediatric strabismus surgery

作　　者：陈恭达[1] 夏瑞[1] 夏晓东[1] 罗高平[1] 毛庆军[1] 罗爱林[2] 

机构地区：[1]长江大学附属第一医院麻醉科,湖北荆州434000 [2]华中科技大学同济医院麻醉教研室

出　　处：《中国医师进修杂志》2010年第6期23-25,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：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（S1、S2、S3组）和普鲁泊福靶控输注组（P1、P2、P3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，、P，组BIS为60，s：、R组BIS为50，s3、R组BIS为40。术中均静脉微泵输注瑞芬太尼[速度0．2μg／（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P1、P2、P3、S1、S2、S3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），P2组和P3组低于P1组，S2组和S3组低于S1组，P3组、S3组、S2组、P2组低于S1组和P1组，S1组低于P1组、S2组低于P2组、S3组低于P3组，差异均有统计学意义（P〈0．05）。普鲁泊福靶控输注浓度P2组[（4．3±0．2）mg]L]和R组[（5．5±0．1）mg／L]高于P，组[（3．2±0．1）mg／L]（P〈0．05）；七氟烷浓度S2组[（1．8±0．3）％]和S3组[（2．3±0．2）％]高于s。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。Objective To observe the effect of sevoflurane and target controlled infusion （TCI） propofol on the oculocardiac reflex （OCR） in patients with paediatric strabismus surgery. Methods One hundred and thirty-eight patients ASA Ⅰ- Ⅱ undergoing strabismus surgery were randomly allocated to six groups（propofol groups： P1, P2, P3 group; sevoflurane groups ：S1, S2, S3 group, 23 cases for each ） according to target bispectral index （BIS） of 60,50 and 40. In propofol groups continuous infusion of propofolremifentanil [0.2 μg/（kg·min）] was adjusted towards target BIS value. The sevofluraneremifentanil [0.2 μg/（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,, P2, P3, S1, S2, S3 group, P2 and P3 group were lower than Pl group, S2 and S3 group were lower than S1 group, P3, S3, S2, P2 group were lower than S1 and P1 group, S1 group was lower than P1 group, S2 group was lower than P2 group, S3 group was lower than P3 group, there was significant difference （P 〈 0.05 ）. The densities of TCI propofol in P2 and P3 group were higher than that in P, 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 S2 and S3 group were higher than that in S1 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.

关 键 词：斜视 普鲁泊福 脑电双频谱指数 七氟烷 

分 类 号：R726[医药卫生—儿科]