学龄前儿童氯胺酮麻醉深度监测的量化研究

Quantitative study on depth of ketamine anesthesia for preschoolers

目的比较学龄前儿童氯胺酮(KTM)麻醉的数量化脑电图和心率变异各指标值差异并将其量化.方法选择学龄前小儿74例,分成A组(4～5岁)、B组(5～6岁)、C组(6～7岁),均肌注KTM5 mg/kg,记录各指标变化,体动时静注KTM 1mg/kg加深麻醉.结果麻醉前A组双频谱指数(BIS)最小,而低频/高频(LF/HF)、心率变异指数(HRVI)最大(P＜0.05).肌注KTM后95%边缘频率下降,其他指标先升高后下降.3组中A组BIS最小,C组LF/HF最大(P＜0.05).切皮前C组BIS较A、B组小(P＜0.05).A、B组BIS＜42时,C组BIS＜33时,切皮体动发生率＜20%.切皮时无体动者BIS,A、B组较C组大(P＜0.05).切皮后C组BIS、LF/HF增大较A、B组明显.术中LF/HF＞10时,体动反应达80%;HRVI＜30时,无体动反应.结论 BIS、HRVI、LF/HF可量化,联合使用可监测KTM麻醉深度.

Objective To compare and quantify the determinants in quantitative electroencephalogram(q-EEG) and heart rate variability power spectrum analysis(HRV-PSA) of ketamme(KTM) anesthesia for preschoolers. Methods Seventy four cases were selected and assigned into 3 groups named A(4-5 years), B(5-6 years), C(6-7 years), 22,28,24 cases in every group respectively. All cases were induced with KTM 5 mg /kg intramuscularly and changes of determinants were recorded continuously. If body movement happened, KTM would be injected with 1 mg/kg. Results On pre- anesthesia, BIS in group A was the least among 3 groups, while LF/HF and HRVI were the largest(P<0.05). At post-injection SEF decreased directly, whereas other parameters ascended for a while, and then descended. Among 3 groups BIS in group A was the least, while LF/HF in group C was the most (P<0.05). BIS in group C was larger than that in group A or B on pre-incision (P<0 05). When BIS in group A, B was less than 42 and that in group C was less than 33 on pre-incision, the movement incidence at incision was less than 20 % . After incision all parameters increased, but BIS and LF/HF in group C increased more greatly than those in Group A and B. BIS of nonmovers in group C was less than those in group A and Bon pre-incision (P<0 05). LF/HF and HRVI at the time of movement were more than those at non movementtime in each group(P<0.01). During operation as LF/HF was more than 10, the body movement probability rose to 80 % Anesthesia was stable when HRVI was under 30. Conclusion Quantified BIS, HRVI and LF/HF can be combined to monitor the depth of KTM anesthesia for preschoolers.JAppl Clin Pediatr,2004,19(11):958 -960