麻醉意识深度指数在儿童射频消融术中应用的临床研究

目的分析麻醉意识深度指数(cerebral state index,CSI)与脑电双频指数(bispectral index,BIS)在监测儿童射频消融术中反映麻醉深度的相关性,评价CSI用于儿科监测的可行性。方法选择全麻下行心律失常射频消融手术的患儿36例,年龄7~15岁,ASAⅠ~Ⅱ级,给予丙泊酚2.5 mg/kg,顺式阿曲库铵0.1 mg/kg,芬太尼1μg/kg诱导后气管插管。麻醉维持期,设定BIS目标区间为60~70,采取闭环模式机器自动调整丙泊酚注药速度,瑞芬太尼0.25~0.33μg·kg^-1·min^-1持续泵注。记录患儿入室时(T 1)、诱导完成时(T 2)、手术开始时(T 3)、手术30 min(T 4)、手术60 min(T 5)、手术90 min(T 6)、停药时(T 7)、拔除气管插管时(T 8)、出室前(T 9)的CSI和BIS,并记录T 7~T 9时的改良清醒镇静评分(modified observers assessment of alertness/sedation scale,MOAA/S)。结果T 1~T 2诱导期、T 3~T 6维持期、T 7~T 9复苏期CSI与BIS的Spearman相关系数分别为0.87、0.84和0.69(P<0.05)。T 1、T 3~T 5时CSI低于BIS(P<0.05),T 8~T 9时CSI高于BIS(P<0.05),T 2、T 6、T 7时,CSI、BIS差异无统计学意义(P>0.05)。T 7~T 9复苏期,CSI与MOAA/S的Spearman相关系数为0.77(P<0.05);BIS与MOAA/S的Spearman相关系数为0.75(P<0.05)。结论在儿童静脉麻醉状态下,CSI与BIS具有良好的相关性,CSI可以用于监测麻醉深度。

Clinical application of cerebral state index during radiofrequency ablation in children

Objective To explore the correlation between cerebral state index(CSI)and bispectral index(BIS)in the monitoring of radiofrequency ablation anesthesia in children and evaluate the feasibility of CSI for pediatric monitoring.Methods Thirty-six children aged 7 to 15 years,ASAⅠtoⅡ,were scheduled for arrhythmic radiofrequency ablation under general anesthesia.Propofol 2.5 mg/kg,cis-atracurium 0.1 mg/kg and fentanyl 1μg/kg were administered for induction.For anesthetic maintenance,a continuous intravenous infusion of propofol was used for maintaining a BIS level of 60 to 70 by a closed-loop mode machine.Remifentanil was continuously infused at a rate of 0.25 to 0.33μg.kg-1.min^-1 for maintaining stable hemodynamics.CSI and BIS were recorded at the timepoints of entering operating room(T 1),completing tracheal induction(T 2),operation starting(T 3),30 min(T 4),60 min(T 5),90 min(T 6),intravenous infusion stopping(T 7),extubation(T 8)and leaving operating room(T 9).The modified awake sedation scores(MOAA/S)were recorded at T 7 to T 9.Results The Spearman s correlation coefficients of CSI and BIS were 0.87,0.84 and 0.69 respectively for T 1 to T 2 induction period,T 3 to T 6 maintenance period and T 7 to T 9 recovery period(P<0.05).CSI was lower than BIS at T 1,T 3 to T 5(P<0.05)and was higher than BIS at T 8 to T 9(P<0.05).No significant difference existed in CSI and BIS at T 2,T 6 and T 7(P>0.05).From T 7 to T 9,the Spearman s correlation coefficient of CSI and MOAA/S and BIS and MOAA/S were 0.77 and 0.75 respectively(P<0.05).Conclusion CSI and BIS have an excellent correlation.And CSI may be used for monitoring the depth of anesthesia during intravenous anesthesia in children.