三种麻醉深度监测方法评价小儿腹部手术镇静效果

THREE METHODS TO EVALUATE THE DEPTH OF ANESTHESIA FOR CHILDREN UNDERGOING ABDOMINAL OPERATION

目的探讨脑电双频指数(BIS)、听觉诱发电位指数(AEPI)及病人状态指数(PSI)在监测小儿腹部手术镇静效果的差异,以选取最佳监测方案。方法 75例患儿分为三组(各组n=25),均使用腰麻+硬膜外联合麻醉,术中辅助咪唑安定维持患儿睡眠,分别使用BIS、AEPI及PSI监测麻醉深度;比较三组在入室(T1)、切皮前60 s(T2)、切皮即刻(T3)、切皮后60 s(T4)及切皮后120 s(T5)进行监测评分;比较改良后OAA/S同一评分下的BIS、AEPI及PSI指数差异,并进行相关性分析。结果 术中三组均无出现切皮体动,但患儿T2～T5四个时间点的BIS、AEPI及PSI指数的组间差异有显著性,且均以PSI最低(p<0.05);OAA/S=0～3分所对应的BIS、AEPI及PSI指数有组间差异(p<0.05),仍均以PSI最低;相关性分析表明上述3个指数与OAA/S评分呈正相关性,且以PSI与OAA/S的相关性最强(r=0.793,p=0.016)。结论 PSI受切皮的影响相对最小,且灵敏度、区分度较好,是监测小儿腹部全麻手术镇静效果较为理想的指标。

Objective To compare the difference between bispectral index（BIS）,auditory evoked potential index（AEPI） and patient state index（PSI） to evaluate the depth of anesthesia for children who needed general anesthesia for abdominal operation.Methods 75 included children were divided into group BIS,AEPI and PSI（all n=25）,and the lumbar combined epidural anesthesia were given to all the children.The indexes of BIS,AEPI and PSI were recorded at the time point of room entry（T1）,60s before skin incision（SI）（T2）,instant of SI（T3）,60s after SI（T4） and 120s after SI（T5） were recorded and compared.The difference between BIS,AEPI and PSI at the same level of OAA/S score was also compared and the relation was analyzed.Results ①There were no case appearing body movement when accepting SI,but the difference between the BIS,AEPI and PSI at the time from T2 to T5 and the lowest indexes were all found in group PSI（p0.05）.②The lowest indexes were also found in group PSI when OAA/S=0,1,2 and 3（p0.05）.③Pearson analysis indicated that there were the positive relation between OAA/S and BIS,AEPI and PSI,and the most apparent relation was found between OAA/S and PSI（r=0.793 and p=0.016）.Conclusion Compared with BIS and AEPI,PSI may be the best index to evaluate the depth of anesthesia for children who needed general anesthesia for abdominal operation for its less influence by skin incision and high sensitivity to discrimination to reflect the level of electrical activity.