BIS监测下小儿尿道下裂修复术中静吸复合麻醉的临床研究  

Clinical research of combined intravenous and inhalation anesthesia in reconstruction of pediatric hypospadias through application of BIS monitoring

作　　者：郭翠容[1] 陆立仁 甘志勇 区梅芬[1] 何碧珍[1] GUO Cui-rong;LU Li-ren;GAN Zhi-yong;OU Mei-fen;HE Bi-zhen(Department of Anesthesiology,Foshan Nanhai Maternity and Child Healthcare Hospital,Foshan 528200,Guangdong,CHINA;Department of Anesthesiology,Nanhai Hospital Affiliated to Southern Medical University,Foshan 528000,Guangdong,CHINA)

机构地区：[1]佛山市南海区妇幼保健院麻醉科,广东南海528200 [2]南方医科大学附属南海医院麻醉科,广东佛山528000

出　　处：《海南医学》2018年第15期2104-2107,共4页Hainan Medical Journal

基　　金：广东省佛山市卫生和计生局医学科研课题(编号:20160191)

摘　　要：目的比较丙泊酚或(和)七氟醚麻醉对小儿尿道下裂修复术中血流动力学、脑电双频指数(BIS)及麻醉复苏情况的影响。方法选取2015年1月至2017年6月在佛山市南海区妇幼保健院择期行尿道下裂修复术1~8岁患儿120例,按随机数表法分为丙泊酚组(P组)、七氟醚组(S组)及丙泊酚联合七氟醚组(C组),每组40例。记录麻醉诱导前(T0)、诱导后2 min(T1)、插入喉罩后即刻(T2)、插人喉罩后5 min(T3)、手术切皮(T4)、术中20 min(T5)和拔除喉罩时(T6)时间点的BIS、心率(HR)、平均动脉压(MAP),手术时间、呼吸恢复时间、意识恢复时间、拔除喉罩的时间,术中知晓、术后喉痉挛、恶心、呕吐情况和术后躁动情况。结果 T4时S组与P组MAP比较,P组较高,差异有统计学意义(P<0.05);T1时S组与C组、P组的BIS比较,C组下降较快,差异均有统计学意义(P<0.05);术后呼吸恢复时间S组与P组、C组比较,P组最快,C组次之,差异均有统计学意义(P<0.05);意识恢复时间和拔除喉罩时间方面,C组与P组、S组比较,C组均为最快,差异均有统计学意义(P<0.05);术后躁动发生率S组与P组比较,S组躁动率最高,差异有统计学意义(P<0.05)。结论丙泊酚复合七氟醚麻醉血流动力学稳定,术后呼吸恢复较快、苏醒时间及拔除喉罩时间均最快,术后躁动率低,结合BIS作为小儿麻醉深度监测,可为小儿尿道下裂手术提供科学、可靠的麻醉方法。Objective To compare the effect of intravenous anesthesia with propofol and（or） inhalation anesthesia with sevoflurane on hemodynamics, bispectral index（BIS） and resuscitation situation during the reconstruction of pediatric hypospadias. Methods One hundred and twenty pediatric patients aged 1-8 years undergoing reconstruction of pediatric hypospadias in Foshan Nanhai Maternity and Child Healthcare Hospital from January 2015 to June 2017 were randomly divided into three groups（forty patients in each group）, namely propofol group（group P）, sevoflurane group（group S）, and propofol combined with sevoflurane group（group C）. BIS, heart rate（HR）, mean arterial pressure（MAP） before induction（T0）, 2 minutes after induction（T1）, the moment when laryngeal mask insertion started（T2）, 5 minutes after laryngeal mask insertion（T3）, the moment of incision（T4）, 20 minutes after the operation started（T5）, and the moment when laryngeal mask was removed（T6） were recorded. The operation duration, the time for respiratory recovery, the time for consciousness recovery, the time for laryngeal mask removal, intraoperative awareness, postoperative laryngeal spasm, nausea, vomiting and postoperative restlessness were observed. Results MAP in group P at T4 was significantly higher than that in group S（P〈0.05）. BIS at T1 showed significant differences in group P or group C compared to group S（P〈0.05）, and that in group C decreased most remarkably. There was significant difference in respiratory recovery time in group S compared with group P or group C（P〈0.05）, which was the shortest in group P, then followed by group C. There was significant difference in the time for consciousness recovery or the time for laryngeal mask removal in group C compared with group P or group S（P〈0.05）, which were fastest in group C. The incidence of postoperative restlessness in group S was significantly higher than that in group P（P〈0.05）. Conclusion Intravenous anesthesia

关 键 词：脑电双频指数 全身麻醉 丙泊酚 七氟醚 小儿尿道下裂修复术 

分 类 号：R614[医药卫生—麻醉学]