脑电双频指数仪在不同年龄全身麻醉患儿中监测麻醉深度的应用

目的探讨在不同年龄患儿全身麻醉中用脑电双频指数仪监测麻醉深度的可行性。方法患儿40例,按美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级为Ⅰ或Ⅱ级,接受全身麻醉,气管插管和择期手术。麻醉用静脉注射丙泊酚/瑞芬太尼诱导,持续静脉输入丙泊酚/瑞芬太尼维持。患儿按年龄分为4组(每组10例):A组(≤3月),B组(>3月,≤2岁),C组(>2岁,≤6岁)和D组(>6岁,≤12岁)。诱导前(T1)、诱导后(T2)、插管时(T3)、切皮时(T4)、停药时(T5)、自主呼吸恢复(T6)和拔管时(T7),做密西根大学镇静评分(University of Michigan Sedation Scale,UMSS),并记录脑电双频指数(bispectralindex,BIS)值。记录麻醉后自主呼吸恢复时间(T5~T6),麻醉后气管拔管时间(T5~T7)。结果(1)各组患儿,T1镇静评分为0~1分;T2时上升,T4为4分,T7回到T1时水平(0~1分)。与此对应,(2)各组患儿T1时的BIS值在96以上,T2时BIS值明显下降,差异有统计学意义(P<0.01),T7回到T1水平。(3)A组患儿与B、C、D组患儿相比,麻醉后气管拔管时间明显延长,差异有统计学意义(P<0.01)。(4)4组患儿麻醉后自主呼吸恢复时间差异无统计学意义。结论在不同年龄全身麻醉患儿中,脑电双频指数仪可以有效监测麻醉深度。

Use of Bispectral Index(BIS) Monitor in Inspecting the Depth of Anesthesia in Pediatric Patients Undergoing General Anesthesia

Objective To investigate the feasibility of using bispectral index(BIS) monitor to inspect anesthesia depth in pediatric patients. Methods Forty pediatric patients(American Society of Anesthesiologists(ASA) Ⅰ-or Ⅱ) undergoing general anesthesia, tracheal intubation and elective surgery were recruited. Anesthesia was induced by the intravenous injection with propofol/remifentanil; maintained by the intravenous infusion with propofol/remifentanil. Patients were classified by age into four groups(10 in each): A(≤3 mo）, B（＞3 mo to 2 yr）, C(>2 yr to 6 yr), and D(>6 yr to 12 yr). Sedation was assessed by the University of Michigan Sedation Scale(UMSS), and BIS value was recorded before the induction(T1), after the induction(T2), at tracheal intubation(T3), at skin incision（T4）, at discontinuation of intravenous propofol/remifentanil（T5）, at the evidence of spontaneous respiration（T6） and at tracheal extubation(T7). Post anesthesia spontaneous respiration recovery time(from T5 to T6) and post anesthesia extubation time(from T5 to T7) were recorded. Results (1) UMSS scores were 0~1 at T1, increased since T2, 4 at T4, decreased to 0~1 at T7 as seen at T1, in a group. Correspondingly, (2) BIS values were above 96% at T1; decreased since T2(P<0.01); increased to the level of T1 at T7, in a group. (3) Average post anesthesia extubation time was longer(P<0.01) in group A than those in groups B, C or D. (4) Average post-anesthesia spontaneous respiration recovery times were not significantly different between any pair of two groups. Conclusion BIS is an indicator of anesthesia depth in pediatric patients undergoing general anesthesia by the propofol/reminfentanil program.