脑电双频指数在小儿斜视手术可唤醒麻醉中的应用  

Application of Bispectral Index Monitoring in Wake-Up Anesthesia During Pediatric Strabismus Surgery

作　　者：蒋耀光[1] 周曲[1] 彭俊敏[1] 

机构地区：[1]长沙医学院附属株洲市三三一医院,湖南株洲412002

出　　处：《医学临床研究》2015年第7期1318-1320,共3页Journal of Clinical Research

摘　　要：【目的】探讨脑电双频指数（BIS）监测在小儿斜视手术可唤醒麻醉中的应用价值。【方法】选择斜视患儿80例随机分为BIS组和对照组，采用瑞芬太尼和丙泊酚给患儿行可唤醒麻醉，B1S组根据BIS值调整瑞芬太尼和丙泊酚的输注速度，对照组根据麻醉师经验、临床体征（如血压，HR，肢动）调整丙泊酚、瑞芬太尼的输注速度。记录麻醉诱导前（T1）、牵拉眼肌时（T2）、唤醒前（T3）、唤醒成功时（T4）、手术结束时（T5）时脉搏血氧饱和度（Sp02）、平均动脉压（MAP）及心率（HR）；记录唤醒时间（从停用镇静药至唤醒成功时间）、麻醉苏醒时间、丙泊酚、瑞芬太尼用量；比较两组患者呼吸抑制、心动过缓、不自主体动、术中知晓、术后恶心呕吐等不良反应的发生情况。【结果】所有患儿各时点MAP、HR和SpO2均在正常范围；与对照组比较，BIS组患儿瑞芬太尼、丙泊酚用量减少，唤醒时间、麻醉苏醒时间缩短；与BIS组比较，对照组呼吸抑制，心动过缓发生率高（P〈0．05），但两组不自主体动、术中知晓、恶心、呕吐的发生率差异无统计学意义（P〉0．05）。【结论】在小儿斜视手术中BIS监测指导可精确控制麻醉深度，术中唤醒快，减少麻醉药用量和麻醉并发症。[Objective] To explore the application of bispectral index （BIS） monitoring in wake-up anes-thesia during pediatric strabismus surgery. [Methods] A total of 80 children of strabismus were randomly divided into ISIS and control groups. And wake-up anesthesia was performed with remifentanil and propofol. In BIS group, the infusion rates of remifentanil and propofol were adjusted according to BIS. In control group, the determinants were handling experience and clinical signs [e. g. blood pressure, heart rate （HR） and extremity movement]. The values of mean arterial pressure （MAP）, HR and （oxygen saturation） SPO2 before induction of anesthesia （T1）, pulling of eye muscle （T2）, before wake-up （T3）, successful wake-up （T4） and at the end of surgery （T5）. And wake-up time （from withdrawing sedatives to successful wake-up）, anesthesia time and doses of propofol and remifentanil were recorded. And respiratory depression, hradycardia, invol-untary body movements, intraoperative awareness and postoperative onsets of nausea and vomiting were compared. [Results] At all timepoints, MAP, HR and SpO2 stayed within normal ranges. As compared with control group, the doses of remifentanil and propofol decreased while wake-up and awareness times declined in BIS group; as compared with BIS group, respiratory depression and bradyeardia were more frequent in control group （ P d0.05）. No significant inter-group differences existed in body movement, intraoperative awareness or onsets of nausea and vomiting （ P 〉0.05）. [Conclusion] During pediatric strabismus surgery, BIS monitoring guidance may accurately control the depth of anesthesia. And it has the advantages of quick wake-up, lower anesthetic doses and fewer complications.

关 键 词：脑电描记术 斜视/外科学 麻醉/方法 二异丙酚/治疗应用 芬太尼/治疗应用 

分 类 号：R777.41[医药卫生—眼科]