BIS指导丙泊酚TCI在小儿眼科手术中的应用

Clinical study of target controlled infusion of propofol by BIS monitoring in children undergoing ophthalmologic operation

目的探讨脑电双频谱指数(BIS)指导丙泊酚靶控输注(TCI)用于小儿眼科手术对血流动力学的影响和术后恢复情况。方法择期行眼科手术的患儿40例,随机分成BIS监测丙泊酚TCI组(Ⅰ组)和丙泊酚静脉注射组(Ⅱ组),每组20例。观察并记录麻醉诱导前、插管前、插管后即刻、手术开始时、手术开始后30min及拔管时6个时间点的BIS值及血液动力学的变化,记录清醒拔管时间,评估术后恶心、呕吐的情况。结果与诱导前相比,两组诱导后SBP、DBP均有下降(P<0.05);Ⅰ组HR的变化与诱导前相比差异无显著性,Ⅱ组较诱导前相比,HR加快且差异有显著性(P<0.05)。气管插管后,Ⅱ组HR明显快于I组(P<0.05);Ⅰ组血压的变化幅度小于Ⅱ组,插管前、插管后即刻与Ⅱ组比较,差异有显著性(P<0.05)。Ⅰ组患者睁眼时间、拔管时间均显著短于Ⅱ组(P<0.01)。结论BIS监测丙泊酚TCI应用于小儿眼科手术麻醉是安全有效的,不仅能够保持围术期血流动力学稳定、减少丙泊酚的用量,而且术后恶心、呕吐发生率低,术后恢复迅速且质量高。

【Objective】To observe the effects of target controlled infusion （TCI） of propofol by bispectral index （BIS） monitoring on hemodynamics in children undergoing ophthalmologic operation and the results of postoperative recovery. 【Methods】Forty children scheduled for ophthalmologic operation were randomly assigned to two groups： target controlled infusion of propofol and BIS monitor group （groupⅠ, n =20） and propofol infusion group （group Ⅱ, n =20）. MAP, HR and BIS were determined before anaesthesia induction, before intubation, immediately after intubation, at the beginning of operation and 30 min after start of operation. Awareness time and postoperative nausea and vomiting （PONV） were assessed after operation. 【Results】SBP and DBP were significantly decreased after operation compared to those before operation in both groups （P 0.05）. After anaesthesia induction, the change of HR was not significant in groupⅠ, while HR significantly increased in group Ⅱ （P 0.05）. HR after intubation in group Ⅱ was markedly faster than that in groupⅠ （P 0.05）.The change of BP was less obvious in group Ⅰ than in group Ⅱ , and BP changes in both groups were significantly different before intubation and immediately after intubation （P 0.05）. The incidence of PONV in group Ⅱ was also lower than that in group Ⅱ （P 0.05）. Awake time and extubation time in group Ⅱ was significantly later than those in group Ⅰ （P 0.05）.【Conclusion】Target controlled infusion of propofol by BIS monitoring is effective in keeping the stability of hemodynamics, making quick awareness and reducing the occurrence of PONV in children receiving ophthalmologic operation.