BIS与CSI在小儿七氟醚麻醉中的临床观察

目的探讨脑电双频指数（BIS）与麻醉意识深度指数（CSI）变化在小儿七氟醚麻醉深度监测的应用价值。方法择期全麻下行眼科手术小儿患者26例,年龄3～12岁,ASAⅠ～Ⅱ级。七氟醚吸入诱导,插入可弯喉罩,术中间歇正压通气（IPPV）,吸入七氟醚,静脉泵注0.1～0.2μg/（kg·min）瑞芬太尼,间断追加维库溴铵维持肌松。记录麻醉诱导前（T0）、诱导后（T1）、插入喉罩后即刻（T2）、呼末七氟醚浓度1%（T3）、1.5%（T4）、2%（T5）、2.5%（T6）及苏醒时（T7）的HR、BP、BIS、CSI值。结果与T0相比,T1、T2时BIS、CSI、MAP均显著降低（P〈0.05）,而HR无明显变化。T1、T2时CSI显著高于同时点的BIS值（P〈0.05）。术中BIS和CSI随七氟醚浓度增加而明显降低（P〈0.05）,与七氟醚spearman等级相关系数r分别为-0.93、-0.90（P〈0.01）,而MAP、HR相关系数为-0.56、-0.42。T7时CSI值显著高于BIS值（P〈0.05）。结论随七氟醚浓度增加,小儿的BIS与CSI值均逐渐降低,与七氟醚浓度呈显著负相关。与BIS相比,CSI在深麻醉时数值下降趋缓,而苏醒期回升速度较快。两者性能均优于HR和BP。

Clinical observation of BIS & CSI on pediatric patients during sevoflurane anesthesia

Objective To investigate the utility of anesthesia depth monitoring on pediatric patients by observing the change of BIS and CSI during sevoflurane anesthesia.Methods Twenty-six pediatric patients （Age 3～12 yr, ASA Ⅰ～Ⅱ） who underwent elective ophthalmic surgery with general anesthesia were included in this study.Anesthesia was in-duced by sevoflurane in oxygen and flexible-LMA were inserted in all patients.Remifentanil was infused at 0.1 ～0.2 μg/（kg·min） during anesthesia and additional muscle relaxants were given if necessary.Data of HR、BP、BIS、CSI were recorded at pre-induction （T0）, post-induction （T1）, with flexible-LMA （T2）, end expriation sevoflurane concentration at 1% （T3）、 1.5%（T4）、2%（T5）、2.5%（T6） respectively and the time of awakeness （T7） was also recorded.Results When compared with baseline, BIS、CSI、MAP of T1、T2 were significantly reduced but HR had no significant changes.At T1、T2, the values of CSI were remarkably higher than those of BIS（P0.05）.BIS and CSI were found to be decreased（P0.05） with the increase of sevoflurane concentration during surgery, and there was significant negative correlation between them.The relative coefficient R of The Sevoflurane were-0.93,-0.90 （P0.01） respectively and those of MAP、HR were-0.56,-0.42.The value of CSI was remarkably higher than that of BIS （P0.05） of T7.Conclusions With the increase of sevoflurane concentration, the BIS and CSI of the children patients decrease gradually and are significantly negatively correlated with the sevoflurane concentration.Compared with BIS, the value of CIS decreases slowly during deep anesthesia, but rebounds fast during the awakening period.The monitoring for BIS and CSI is better than HR and BP.