脑电双频谱指数对小儿手术中低浓度七氟醚复合瑞芬太尼麻醉后意识状态的监测  

Bispectral index in children with surgical Sevoflurane in low concentrations of remifentanil anesthesia monitoring the state of consciousness

作　　者：武建华[1] 武建辉[2] 

机构地区：[1]河北联合大学附属医院麻醉科,河北唐山063000 [2]河北联合大学公共卫生学院,河北唐山063000

出　　处：《中国医药导报》2012年第5期78-80,共3页China Medical Herald

摘　　要：目的探讨脑电双频谱指数(BIS)对小儿脊柱侧弯矫形术中低浓度七氟醚复合瑞芬太尼麻醉的意识状态监测作用,评价麻醉方法的有效性、安全性和优越性。方法将30例小儿脊柱侧弯矫形术患者随机分为A组和B组,各15例。于术中切皮前10 min分别予七氟醚最小肺泡浓度(MAC)1.0、1.5联合瑞芬太尼靶控输注,于切开硬膜即刻(T0)、切开硬膜1 h后(T1)、2 h后(T2)、关闭硬膜即刻(T3)各个时点分别采取颈内静脉球部血及桡动脉血进行血气分析,采用警觉/镇静(OAA/S)评分评价意识状态变化。两组患者每3分钟进行一次OAA/S评分,直至患者对轻推无反应(定义为意识消失)后停止给药。记录每次评分前即刻的BIS值及血流动力学指标,分析BIS与OAA/S评分的关系并计算BIS预测镇静深度的概率(Pk),通过Pk评价BIS对神经功能状态的预测效果。结果随着七氟醚复合瑞芬太尼效应室靶浓度(Ce)增加,两组患者BIS逐渐降低,两组总体变化趋势一致。患者意识消失时,BIS值:A组(61.6±7.9),B组(72.9±5.9);Ce:A组(69.8±8.9)μg/L,B组(53.3±9.4)μg/L。同一镇静评分(OAA/S 4～1)时,B组的BIS值明显高于A组。两组BIS对于意识消失的预测概率(Pk)分别:A组(0.883±0.034),B组(0.819±0.028)。目标控制输注(TCI)期间两组心率和脉搏血氧饱和度无明显改变。与基础值比较,当OAA/S评分降至2以下时,血压下降(P<0.05)。结论 1.0 MAC或1.5 MAC七氟醚联合瑞芬太尼麻醉期间,BIS能准确的预测意识状态的变化。Objective To study the BIS for children scoliosis orthopaedic surgery low concentration sevoflurane composite Rachel fentanyl anesthesia awareness of condition monitoring role,the validity of the method of anesthesia evaluation,safety and superiority.Methods 30 cases of pediatric scoliosis orthopedic surgery were randomly divided into group A and group B with 15 cases of each group.At 10 min before skin incision surgery,respectively,patients were treated with 1.0,1.5 MAC of Sevoflurane combined with Remifentanil target-controlled infusion,immediately at the dural incision（T0）,1 h after dural incision（T1）,2 h after dural incision（T2）,immediately close the dura mater（T3） each time point were taken jugular bulb and radial arterial blood gas analysis,using the alert/Sedation（OAA/S） score evaluation of the state of consciousness changes.Two groups of patients every 3 min were evaluated of OAA/S score once,until no reaction push patients（defined as loss of Consciousness） after stopping administration.Recorded each score immediately before the BIS values and hemodynamic parameters,analysis of BIS and OAA/S score and calculate the relationship between the BIS predicted sedation probability（Pk）,Pk evaluation by the BIS on the neurological status of the prediction.Results With the Sevoflurane Remifentanil Ce increasing,both groups BIS decreased,consistent with two general trends.Patients with loss of consciousness,BIS values： A group of（61.6±7.9）,B group（72.9±5.9）.Ce： A group（69.8±8.9） ng/mL,B group（53.3 ± 9.4） ng/mL.The sedation score（OAA/S4-1） of B group was significantly higher than the BIS group A.Two sets of BIS for unconsciousness prediction probability（Pk）： A group was（0.883±0.034）,B group was（0.819 ± 0.028）.TCI during the two heart rate and pulse oxygen saturation did not change significantly.Compared with baseline,when the OAA/S score dropped to 2 below,blood pressure decreased（P0.05）.Conclusion 1.0 MAC or 1.5 MAC Sevoflurane combined with

关 键 词：脑电双频指数 低浓度 七氟醚 瑞芬太尼 意识状态 监测 

分 类 号：R614[医药卫生—麻醉学]