BIS监测在小儿室间隔缺损介入术麻醉中的应用

Application of bispectral index in interventional therapy of ventricular septal defect of children

目的:通过观察脑电双频指数(BIS)用于经皮心导管介入封堵小儿室间隔缺损手术麻醉深度的监测,评价其对小儿先天性室间隔缺损介入术麻醉的影响。方法:择期行先天性室间隔缺损封堵术患儿60例,随机分为BIS监测组(A组,30例)和警觉/镇静评分组(B组,30例)。记录麻醉诱导前、诱导后1 min、手术开始时、术中、术毕、患儿苏醒时各时点患儿心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2),记录丙泊酚用量,需要辅助呼吸的例数、时间,患儿苏醒时间、术后有无恶心呕吐及呼吸抑制。结果:60例患儿麻醉效果均满意,两组HR、MAP、SpO2相比,均无统计学差异(P>0.05);A组术中呼吸抑制的例数、辅助呼吸时间、患儿苏醒时间、丙泊酚用量均明显少于B组(P<0.05);术后两组患儿均无恶心呕吐及呼吸抑制。结论:在小儿室间隔缺损封堵术中应用BIS监测可正确判断麻醉深度,使术中患儿呼吸循环稳定,静脉全麻药物用量明显减少,患儿苏醒时间明显缩短,提高了麻醉质量,具有较高的安全性和可行性。

Objective： To evaluate the feasibility and safety of bispectral index（BIS） monitoring in interventional therapy of ventricular septal defect of children.Methods： Sixty children aged 2-9 years old,scheduled for interventional therapy of ventricular septal defect,were randomly divided into two groups.In group A children received BIS monitoring during the operation（n=30）,and the group B received Observer＇s Assessment of Alertness/Sedation（OAA/S） scale（n=30）.All the children were anesthetized with basal anesthesia,completed with ketamine 4 mg·kg-1.In the two groups,the anesthesia was maintained with propofol at dose of 5 mg·kg-1·h-1 to 9 mg·kg-1·h-1 continuous intravenous infusion.The concentration was adjusted to maintain the BIS values between 50-65 in group A and OAA/S scale about 1 in group B respectively.The heart rate（HR）,mean arterial pressure（MAP） and pulse oximetric saturation（SpO2） were measured before anesthetic inducement,1 min after inducement,at the start of operation,during the operation,at the end of operation and after recovery of children respectively.The requirements of propofol,time of supporting ventilation and recovery,the respiration depression,postoperative nausea and vomit were also recorded.Results： The anesthesia results of all patients were satisfied.The intraoperative HR,MAP and SpO2 showed no differences between two groups,but the requirements of propofol,the times of supporting ventilation and recovery were less in group A than that in group B（P0.05）.All children hadn＇t nausea,vomit and respiratory depression and no other adverse effect was found.Conclusion： The results suggest that in interventional therapy of ventricular septal defect operation,BIS monitoring has the advantages of timely adjustment of anesthetic depth,reducing anesthetic requirements,shortening the time of recovery,which could be used effectively and safely.