脑状态指数在小儿低温等离子扁桃体切除术全凭静脉麻醉中的应用观察  

Clinical Application of Cerebral State Index in Total Intravenous Anesthesia in Children Undergoing Low Temperature Plasma Tonsillectomy

作　　者：李娜[1] 冷福建[1] 乐林莉[1] 程静[1] 乐呈进[1] 陈林[1] 余凌[1] 

机构地区：[1]湖北省妇幼保健院麻醉科,湖北武汉430070

出　　处：《武汉大学学报（医学版）》2015年第4期636-639,共4页Medical Journal of Wuhan University

摘　　要：目的:探讨脑状态指数(CSI)在小儿低温等离子扁桃体切除术中对全凭静脉麻醉深度的监测和调控作用。方法:择期行低温等离子扁桃体切除术的患儿60例,年龄3-7岁,体重12-38kg,ASA I或Ⅱ级,采用随机数字表法,将其分为两组(n=30):对照组(Ⅰ组)和观察组(Ⅱ组),两组均行CSI监测。Ⅰ组采用常规麻醉诱导和麻醉维持方法,Ⅱ组通过维持CSI值于50.02±5.01来调整异丙酚的靶浓度值,其余用药同Ⅰ组。观察记录麻醉诱导前(T0)、插管后1min(T1)、放置开口器时(T2)、扁桃体切除时(T3)、手术结束时(T4)、拔管后10min(T5)的心率(HR)、收缩压(SBP)、舒张压(DBP)和CSI,比较两组异丙酚和瑞芬太尼用量,患儿苏醒、拔管、离开复苏室时间及术中知晓、术后躁动等情况。结果:与T0比较,Ⅰ组HR、SBP、DBP在T1、T2、T3、T4时间点明显降低(P<0.05);与T0比较,Ⅱ组HR在T2、T3、T4时间点明显减少,差异均有统计学意义(P<0.05),在Tl、T5时间点差异无统计学意义(P>0.05),Ⅱ组SBP、DBP在各时间点差异无统计学意义(P>0.05);与Ⅰ组比较,Ⅱ组Tl、T2、T3、T4各时点的HR、SBP、DBP、CSI值明显升高,而异丙酚用量较少,苏醒、拔管和离开复苏室时间缩短,组间比较差异有统计学意义(P<0.05);两组患儿T0、T5时点的HR、SBP、DBP、CSI差异无统计学意义(P>0.05);两组患儿均无术中知晓,术后躁动等并发症比较差异无统计学意义(P>0.05)。结论:通过CSI监测为小儿全凭静脉麻醉的麻醉深度提供量化指标,可避免麻醉过深、减少异丙酚用量、缩短复苏时间、防止术中知晓。Objective： To evaluate the monitoring and regulation role of cerebral state index （CSI） in the depth of total intravenous anesthesia in children undergoing low temperature plasma tonsillecto- my. Methods： Sixty ASA Ⅰ orⅡ patients aged 3-7 years weighing 12-38 kg undergoing elective low temperature plasma tonsillectomy under total intravenous anesthesia were randomly divided into two groups（n=30 each） ： control group（group Ⅰ ） and CSI monitoring group （group Ⅱ ）. All patients were monitored by CSI. The dosage of propofol in group ⅡⅡ was adjusted according to the value of CSI which maintained at 50.02!5.01 while group I were induced and maintained with conventional method. The same anesthetic was used in both groups. HR, SBP, DBP, andCSI were recorded at time points, before induction（T0）, 1 minute after intubation（T1 ）, the mouth gag put（T2）, the tonsils removed（T3）, the end of operation （T4）, and 10 minutes after extuba- tion（T5）. The anesthetic dosage, awakening time, extubation time,leaving PACU time, intraop- erative awareness, and postoperative agitation were recorded. Results： Compared with those at To, HR, SBP, and DBP decreased significantly at time points T1, T2 ,T3 and T4in group Ⅰ （P〈 0.05）. Compared with To, HR decreased at time points T2 ,T3 ,T4 （P〈0.05）, but there was no difference at time points T1 and T5 in group Ⅱ （P〉0.05） ; and there was no statistical difference in SBP and DBP in group Ⅱ （P〉0.05）. Compared with those in group Ⅰ , HR, SBP, DBP, and CSI increased significantly at time points T1, T2 ,T3 and T4 （P〈0.05） ,and the amount of propo- fol, awakening time, extubation time, leaving PACU time significantly decreased in group Ⅱ （P d0.05）. The incidence of intraoperative awareness was not observed and there was no statistical difference at time points To and T5 in HR,SBP,DBP,CSI and postoperative agitation between the two groups （P〉0.05）. Conclusion： The application of CSI in monitori

关 键 词：脑状态指数 儿童 麻醉 静脉 低温等离子扁桃体切除术 

分 类 号：R614.2[医药卫生—麻醉学]