小儿腹腔镜麻醉中右美托咪定-脑电双频指数分式探讨与构建  

Exploration and construction of Dexmedetomidine-Bispectral index fraction(DEX-BIF)in pediatric laparoscopic anesthesia

作　　者：蔡军[1] 于刚[1] 颜建娥[1] 侍海碧[1] 武玉清 CAI Jun;YU Gang;YAN Jiane;SHI Haibi;WU Yuqing(Department of Anesthesiology,Maternal and Child Health Hospital of Lianyun-gang City,Lianyungang Jiangsu 222002,China)

机构地区：[1]连云港市妇幼保健院麻醉科,江苏连云港222002 [2]徐州医科大学麻醉药理学教研室,江苏徐州221000

出　　处：《中国急救复苏与灾害医学杂志》2022年第5期651-654,667,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：江苏省妇幼健康科研项目(编号:F201859)。

摘　　要：目的探讨腹腔镜术中不同剂量右美托咪定(DEX)与小儿脑电双频指数(BIS)间的量化关系,模拟构建右美托咪定-脑电双频指数分式(DEX-BIF),指导临床用药。方法2~7岁腹腔镜术患儿,随机分为A、B、C组和对照组,每组20例。A、B、C组全身麻醉前分别静脉泵注0.3、0.5、0.7μg/kgDEX(稀释至30 mL),对照组泵注生理盐水30 mL。比较四组用药前(T0)、用药后(T1)、插管(T2)、切皮(T3)、术中15 min(T4)和术毕(T5)时BIS、平均动脉压(MAP)、心率(HR)波动,记录术后苏醒时间、Ramsay镇静评分和疼痛视觉模拟评分(VAS),分析量化关系并模拟构建DEX-BIF。结果DEX预处理后A、B、C组BIS、MAP、HR、Ramsay评分及VAS较对照组有明显差异(P<0.05),其中B、C组术后疼痛和躁动发生较A组显著减少(P<0.05),实验组DEX剂量和BIS间存在量化关系;四组术后苏醒时间无明显差异(P>0.05)。结论0.5~0.7μg/kgDEX可使小儿获得更佳的镇静、镇痛效果且不延长苏醒时间,血液动力学稳定,躁动减少,有临床指导价值。DEX和BIS间存在量化关系,可据此模拟DEX-BIF并用于临床。Objective To explore the quantitative relationship between different doses of dexmedetomidine(DEX)and bispectral index(BIS)in children undergoing laparoscopic surgery,and to simulate the construction of dexmedetomi⁃dine bispectral index fraction(DEX-BIF)to guide clinical medication.Methods 2~7 years old children to be per⁃formed laparoscopic surgery were selected and randomly divided into four groups according to different doses of DEX:Group A(0.3μg/kg);Group B(0.5μg/kg);Group C(0.7μg/kg)and control group(physiological saline),each group had 20 cases.15 minites before general analgesia,the children were separately intravenou pumped 0.3,0.5 and 0.7μg/kg DEX(diluted to 30 mL)in group A,B and C while pumped 30 mL physiological saline in control group.The four group's MAP,HR,BIS on the following time points:berore injection induction(T0),after injection induction(T1),tracheal can⁃nula time(T2),surgery initiation(T3),15minites in surgery(T4)and end of surgery(T5)were monitored,and postopera⁃tive recovery time,Ramsay sedation score and visual analogue scale(VAS)were recorded.The quantitative relationship was analyzed and DEX-BIF was simulated.Results There were significant differences in BIS,MAP,HR,Ramsay scores and VAS between experience groups and control group(P<0.05),the incidence of postoperative pain and agita⁃tion in group B and C was significantly lower than that in group A(P<0.05),there seemed to be a quantitative relation⁃ship between the dose of DEX and the BIS in the experiment groups;there was no significant difference in postopera⁃tive recovery time among the four groups(P>0.05).Conclusion 0.5~0.7μg/kg DEX can obtained better effects of seda⁃tive and analgesic without prolonging the palinesthesia time,with stable hemodynamics and less agitation.There is a quantitative relationship between DEX and BIS,which can be used to simulate DEX-BIF.

关 键 词：右美托咪定 脑电双频指数 右美托咪定-脑电双频指数分式 小儿 腹腔镜手术 

分 类 号：R614.27[医药卫生—麻醉学]