七氟烷暴露新生儿术后早期脑干听觉诱发电位的变化

Effect of sevoflurane exposure on early postoperative brainstem auditory evoked potential in newborns

目的:观察七氟烷暴露新生儿术后早期脑干听觉诱发电位的变化。方法:行胃肠手术新生儿60例,胎龄37～42周,出生体重≥2 500 g,出生后1 min和5 min Apgar评分≥8分,ASAⅠ或Ⅱ级,按七氟烷暴露剂量,将患儿随机均分为3组(n=20):呼气末七氟烷浓度(CET-SEV)×吸入七氟烷时间(h)≤3.3%组(S1组)、3.3%<CET-SEV×吸入七氟烷时间(h)<6.6%组(S2组)、CET-SEV×吸入七氟烷时间(h)组≥6.6%(S3组),同期选取符合纳入标准、未接受手术的新生儿20例作为对照组(C组,n=20)。实验组以4%七氟烷行吸入诱导,术中以七氟烷维持,采用气体监护仪监测呼气末七氟烷浓度。实验组在术后48 h和7天分别测试脑干听觉诱发电位(BAEP),对照组同期测试BAEP。结果:术后48 h时七氟烷暴露组BAEP异常率为45%,主要表现为Ⅴ波分化不良或消失、Ⅴ波潜伏期(PL)延长、I-Ⅴ波波间期(IPL)延长,与C组比较,S2组与S3组BAEP异常率及S3组I-Ⅴ波IPL差异有统计学意义(P<0.05);术后7天时七氟烷组BAEP主要表现为Ⅴ波PL延长、I-Ⅴ波IPL延长,与C组比较,BAEP异常率、PL及IPL差异均无统计学意义(P>0.05)。结论:吸入较大剂量七氟烷新生儿术后早期出现一过性BAEP异常。

Objective： To observe the effect of sevoflurane exposure on early post - operative brainstem auditory evoked potential in newborns. Methods： sixty ASA I or II newborns, gestated from 37 to 42 weeks, weighing over 2 500 g, 1 minute and 5 minutes Apgar scores not less than 8, undergoing gastrointestinal operations were divided into 3 groups （ n = 20 each） ： endtidal concentration of sevoflurane （ CET - SEV） x hour ~〈 3. 3% group （ group $1 ）, 3. 3% 〈 CET - SEV x hour 〈 6. 6% group （ group $2 ） and 6. 6% ~〈 CET - SEV x hour group （group $3 ） . Twenty neonates borned meanwhile, in according with enrolled standards, undergoing sham operation, were taken as control group （ group C, n = 20 ） . Newborns in trial groups were induced with 4% sevoflurane, maintained with sevoflurane. Gas mornitor was taken to assay concentration of sevoflurane. Newborns in trial groups underwent brainstem auditory evoked potential （BAEP） at postoper- ative 48 h and 7 d, Newborns in control group were done at the same time. Results： At postoperative 48 h, abnormality of BAEP of sevoflu- rane in exposure groups were 45% , those manifested blave V differentiated abnormally or disappeared, potential latency （PL） of blave V prolonged as well as interval potential latency （IPL） of blave I ~ V. Compared with group C, abnormality of $2 and $3 were significantly higher （ P 〈 0.05 ） . IPL of blare I - V were significantly longer in group $3 than those of group C （ P 〈 0.05 ） , nevertheless, at postopera- tive 7 d unsignificantly （ P 〉 0. 05 ） . Conclusion ： During early postoperative stage BAEP occur to be temporarily abnormal among neonates with sevoflurane exposure.