SedLine脑功能监测指导全凭静脉麻醉用于儿童尿道下裂手术的效果  

Efficacy of SedLine Brain Function Monitor-guided total intravenous anesthesia for children undergoing hypospadias surgery

作　　者：马锐 毛予 秦霈 刘芯 李婵[1] 王娟宁 丁卫 杨丽芳 Ma Rui;Mao Yu;Qin Pei;Liu Xin;Li Chan;Wang Juanning;Ding Wei;Yang Lifang(Department of Anesthesiology and Perioperative Medicine,Children′s Hospital of Xi′an Jiaotong University,Xi′an 710003,China;Department of Cardiovascular Surgery,Xijing Hospital of Air Force Medical University,Xi′an 710032,China)

机构地区：[1]西安交通大学附属儿童医院麻醉与围术期医学科,西安710003 [2]空军军医大学附属西京医院心血管外科,西安710032

出　　处：《中华麻醉学杂志》2024年第11期1361-1365,共5页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金(82174493);西安英才计划领军(创新人才)(XAYC210024);陕西省科技厅重点项目-关键核心技术攻关项目(2024SF-GJHX-21);陕西省卫生健康科研创新能力提升计划立项项目(2024TD-20)。

摘　　要：目的评价SedLine脑功能监测指导全凭静脉麻醉用于儿童尿道下裂手术的效果。方法本研究为随机对照试验。择期行尿道下裂手术患儿161例,年龄1~10岁,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为SedLine组(S组,n=83)和对照组(C组,n=78),S组术中维持95%谱缘频率(SEF95)14~18 Hz,状态指数(PSI)25~50,C组维持MAP 60~80 mmHg,HR 80~110次/min。于诱导前(T_(1))、气管插管(T_(2))、气管插管后5 min(T_(3))、气管插管后10 min(T_(4))、手术开始(T_(5))、手术开始30 min(T_(6))、手术开始1 h(T_(7))和手术结束(T_(8))时记录患儿PSI和SEF95;记录2组患儿麻醉总时间、手术时间、停药至气管拔管时间、麻醉后恢复室停留时间、丙泊酚、瑞芬太尼用量、术中不良事件的发生情况、5点评分量表及麻醉苏醒期谵妄评分。结果与C组比较,S组麻醉总时间、停药至气管拔管时间和麻醉后恢复室停留时间缩短,丙泊酚诱导和维持用量减少,T_(5-8)时PSI、T_(2-6)时SEFL95和T_(2-8)时SEFR95升高,术中体动反应发生率和苏醒期躁动发生率降低(P<0.05)。结论SedLine脑功能监测指导全凭静脉麻醉用于儿童尿道下裂手术的效果较好。Objective To evaluate the efficacy of SedLine Brain Function Monitor-guided total intravenous anesthesia for children undergoing hypospadias surgery.Methods This was a randomized controlled trial.A total of 161 children,aged 1-10 yr,with American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ,scheduled for elective hypospadias surgery,were divided into SedLine group(S group,n=83)and control group(C group,n=78)using a random number table method.In group S,95% spectral edge frequency(SEF 95)was maintained at 14-18 Hz,and the patient state index(PSI)was maintained at 25-50 during surgery.In group C,mean arterial pressure was maintained at 60-80 mmHg,and heart rate was maintained at 80-110 beats/min during surgery.PSI and SEF 95 were recorded before induction(T_(1)),at 0,5 and 10 min after intubation(T_(2-4)),at the beginning of surgery(T_(5)),at 30 min and 1 h after surgery(T_(6,7)),and at the end of surgery(T_(8)).The anesthetic duration,operation time,time from withdrawal to extubation,postanesthesia care unit duration,consumption of propofol and remifentanil,intraoperative adverse events,5-point Likert scale scores,and emergence delirium scores were recorded.Results Compared to C group,the total anesthesia time,time from withdrawal to extubation and postanesthesia care unit duration were significantly shortened,the consumption of propofol for both induction and maintenance was reduced,the PSI at T_(5-8),SEFL 95 at T_(2-6),and SEFR 95 at T_(2-8) were increased,and the incidence of intraoperative body movement and incidence of emergence agitation were decreased in S group(P<0.05).Conclusions SedLine Brain Function Monitor-guided total intravenous anesthesia provides better efficacy when used for the children undergoing hypospadias surgery.

关 键 词：脑 麻醉 静脉 儿童 尿道下裂 外科手术 

分 类 号：R726.1[医药卫生—儿科]