脑电小波指数监测患儿丙泊酚镇静深度的可行性  

Feasibility of wavelet index in monitoring depth of sedation with propofol in pediatric patients

作　　者：訾婷婷[1] 张建敏[1] 彭晓霞[2] 李立晶[1] 于洁[1] 田沐洋[1] 崔晓环 王芳[1] Zi Tingting;Zhang Jianmin;Peng Xiaoxia;Li Lijing;Yu Jie;Tian Muyang;Cui Xiaohuan;Wang Fang(Department of Anesthesiology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Center for Clinical Epidemiology&Evidence-Based Medicine,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院手术麻醉科,北京100045 [2]国家儿童医学中心,首都医科大学附属北京儿童医院临床流行病与循证医学中心,北京100045

出　　处：《中华麻醉学杂志》2024年第8期1000-1005,共6页Chinese Journal of Anesthesiology

摘　　要：目的评价脑电小波指数(WLI)监测患儿丙泊酚镇静深度的可行性。方法本研究为前瞻性观察性试验。选择本院2016年7月至12月需行气管插管或喉罩全麻的择期手术患儿165例,年龄>1~12岁,ASA分级Ⅰ或Ⅱ级,按年龄分为11组(n=15):>1~2岁组、>2~3岁组、>3~4岁组、>4~5岁组、>5~6岁组、>6~7岁组、>7~8岁组、>8~9岁组、>9~10岁组、>10~11岁组、>11~12岁组。静脉注射丙泊酚3 mg/kg,注射时间>30 s。于给药前即刻、给药结束后30、40、50、60、90、120、180、240 s时记录WLI值与BIS值。如年龄组之间存在差异,则合并差异无统计学意义的年龄组,重新分组。WLI值与BIS值的相关性采用Pearson线性相关分析,WLI值与BIS值的一致性分析采用Bland-Altman法。结果实际入组患儿149例。>1~5岁的4组之间、>5~12岁的7组之间BIS值比较差异无统计学意义(P>0.05)。根据上述结果重新分组,>1~5岁的4组患儿合并为>1~5岁组(n=60),>5~12岁的7组患儿合并为>5~12岁组(n=89)。与给药前即刻比较,2组给药结束后各时点WLI值和BIS值降低(P<0.05)。2组BIS值均于给药结束后60 s时最低,WLI值于给药结束后120和180 s最低(P<0.05)。>1~5岁组给药结束后90和240 s时WLI值与BIS值比较差异无统计学意义(P>0.05),其余时点比较差异有统计学意义(P<0.05);>5~12岁组给药结束后180和240 s时WLI值与BIS值比较差异无统计学意义(P>0.05),其余时点比较差异有统计学意义(P<0.05)。>1~5岁组和>5~12岁组WLI值与BIS值Pearson相关系数分别为0.61和0.56(P<0.001)。Bland-Altman一致性分析:>1~5岁组和>5~12岁组95%一致性区间界限分别为-48.4%~62.1%、-55.1%~101.5%,分别有4.6%(23/504)、5.1%(40/777)的点在95%一致性界限之外,2组95%一致性区间界限均超出临床可接受范围。结论WLI可监测>1~12岁患儿丙泊酚镇静深度,但相比BIS,其准确性较低。ObjectiveTo assess the feasibility of wavelet index(WLI)in monitoring the depth of sedation with propofol in pediatric patients.MethodsThis was a prospective observational trial.One hundred and sixty-five pediatric patients,aged>1-12 yr,of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,undergoing elective surgery requiring general anesthesia with endotracheal intubation or laryngeal mask airway from July to December 2016 in our hospital,were divided into 11 age groups(n=15 each):>1-2 yr group,>2-3 yr group,>3-4 yr group,>4-5 yr group,>5-6 yr group,>6-7 yr group,>7-8 yr group,>8-9 yr group,>9-10 yr group,>10-11 yr group,and>11-12 yr group.General anesthesia was induced by injection of propofol 3 mg/kg for more than 30 s.WLI and BIS values were recorded immediately before administration and at 30,40,50,60,90,120,180 and 240 s after the end of administration.If there were differences among age groups,age groups with no statistically significant differences were combined and re-grouped.Pearson linear correlation analysis and Bland-Altman consistency analysis were performed.ResultsA total of 149 pediatric patients were actually included.There were no significant differences in BIS values between 4 groups aged>1-5 yr and between 7 groups aged>5-12 yr(P>0.05).Regrouping was performed based on the aforementioned results,4 groups of children aged>1-5 yr were divided into>1-5 yr group(n=60),and 7 groups of children aged>5-12 yr were divided into>5-12 yr group(n=89).WLI values and BIS values were significantly decreased at each time point after administration compared with immediately before administration in group aged>1-5 yr and in group aged>5-12 yr(P<0.05).The BIS values were the lowest at 60 s after the end of the administration,and the WLI values were the lowest at 120 and 180 s after the end of the administration in two groups(P<0.05).There were no statistically significant differences between WLI values and BIS values at 90 s and 240 s after the end of the administration(P>0.05),and the

关 键 词：脑电描记术 二异丙酚 麻醉 静脉 儿童 

分 类 号：R726.1[医药卫生—儿科]