异丙酚靶控输注时成人与小儿BIS的比较

Difference in BIS level between adults and children during target-controlled infusion of propofol

目的探讨脑电双频谱指数（BIS）监测小儿麻醉深度的准确性,比较异丙酚靶控输注（TCI）麻醉中小儿与成人BIS的差异。方法择期手术病人68例,分为年幼组（A组,3～5岁,n= 20）、年长组（B组,6～12岁,n=20）和成年组（C组,18～55岁,n=28）,采用异丙酚TCI,初始血浆靶浓度3μg/ml,每30秒增加0.3μg/ml,意识消失（LOC）、意识恢复（ROC）时记录异丙酚的血浆靶浓度（Cp）、效应室浓度（Ce）及BIS。Ce=Cp达到2、3、4、5、6μg/ml时记录BIS。结果3组病人的BIS随着异丙酚Cp的增加而明显下降（P〈0.01）;A组和B组BIS与Cp的相关性高于C组（P〈0.01）;在相同的Cp和Ce下A组和B组的BIS均明显高于C组,A组高于B组（P〈0.01）;A组、B组和C组BIS≤40时的异丙酚Ce分别平均为6、5、3μg/ml;A组LOC和ROC时的BIS明显高于C组（P〈0.01）;C组LOC时的异丙酚Ce明显低于A组（P〈0.01）。结论在相同的异丙酚Cp和Ce下,小儿与成人BIS差别较大,年龄越小,BIS越高;在意识消失和意识恢复时,年幼小儿的BIS明显高于成人。

Objective To investigate the difference in the relationship of bispectral index （BIS） to depth of anesthesia between adults and children. Methods Sixty-eight ASA Ⅰ or Ⅱ patients undergoing elective surgery were divided into 3 age groups： group A young children 3- 〈 6 yr, n = 20） ; group B older children （6-12 yr, n = 20） and group C adults （ n = 28）. The patients were premedicated with intramuscular pethidine 1 mg/kg and promethazine 1 mg/kg （in children） or 25 mg （in adults）, and anesthetized with target-controlled infusion （TCI） of propofol. The initial target plasma concentration of propofol （Cp） was set at 3μ/ml and increased by 0.3 μ/ml every 30 seconds until the patients lost BIS values at LOC and recovery of （LOC）. The Cp and target effect-site concentration （Ce） and （ROC） were recorded. BIS values were also recorded when Cp = Ce = 2, 3, 4, 5, 6μ/ml. Results The BIS values were significantly decreased as Cp was increasing （ P 〈 0.01）. The correlation between BIS values and Cp was significantly better in children （group A and B） than in adults （group C）. At the same Cp and Ce BIS values were highest in group A and lowest in group C （group A 〉 group B 〉 group C）. When BIS values≤40, Ce = 6μ/ml in group A, 5μ/ml in group B and 3μ/ml in group C on average. At LOC and ROC BIS values in group A were significantly higher than those in group C, but there was no significant difference in BIS values between group B and C. At LOC and ROC there was no significant difference in Cp among the 3 groups. At LOC Ce in group C was significantly lower than that in group A （ P 〈 0.01） .Conclusion At the same Cp and Ce there is significant difference in BIS values between children and adults, the younger the age, the higher the BIS value. The BIS values are higher in young children than in adults.