熵指数监测联合肌松监测在儿童全麻诱导期的临床观察

Clinical observation of combination of entropy index and neuromuscular block monitoring during inducing period of global anaesthesia in children

目的观察熵指数监测联合肌松监测在儿童全麻诱导期的应用效果，并评价气管插管的最佳时机。方法选择100例择期行扁桃体加腺样体切除术的全麻儿童，美国麻醉医师协会（ASA）分级为I或Ⅱ级，年龄6～12（9．2±1．7）岁，随机分为两组，每组50例，试验组：熵指数监测联合肌松监测组；对照组：不采用熵指数监测联合肌松监测组。观察并记录两组在麻醉前（T0）、诱导后1min（T1）、气管插管后1rain（T2）、气管插管后5min（T3）时的血压和心率；两组患者的气管插管条件和声门暴露程度；两组肌松药推注完毕到气管插管的时间和丙泊酚的用量。结果两组的血压和心率在T1时均下降，在T2时均上升，但试验组的收缩压和心率与对照组相比升高的幅度较小，差异有统计学意义（P〈0．05），舒张压的变化不明显。对照组中，收缩压和心率在T2时与T0和T1相比较，升高明显，差异有统计学意义（P〈0．05），而试验组则变化不明显。试验组的气管插管条件和声门暴露程度均好于对照组（P〈0．01）。试验组中肌松药推注毕到气管插管的时间明显长于对照组（P〈0．01）。试验组丙泊酚的用量虽多于对照组，但差异无统计学意义（P〉0．05）。结论在熵指数监测和肌松监测下，儿童全麻诱导期的血流动力学维持比较稳定，气管插管条件和声门暴露程度较好。熵指数维持在40-50范围内并且肌松监测的T1肌颤搐抑制〉90％时是气管插管的最佳时机。

Objective To observe clinical effieiency of combination of entropy index and neuromuscular block monitoring during in- ducing period of global anaesthesia in children and evaluate the best time for tracheal intubation. Methods One hundred pediatric patients aged 6 to 12 （9.2 ± 1.7） years old scheduled for elective tonsillectomy and adenoidectomy were randomly divided into two groups, i.e. trial group （ u = 50） and control group （ n = 50）. The trial group received the guidance of combination of entropy in- dex and neuromuscular block monitoring, while the control group didn＇ t. The blood pressure and heart rate were observed and re- corded at pre-anesthesia （ t0 ） , 1 rain after anesthesia induction （ t1 ） , 1 min （ t2 ） and 5 rain （ t3 ） after tracheal intubation. Tracheal intubation conditions and the vocal cord visibility were evaluated and recorded. The times from the completion of the intravenous in- jection of muscle relaxant to tracheal intubation and propofol consumption were also recorded. Results The systolic blood pressure and the heart rate at t2 were higher in the control group than in trial group; the systolic blood pressure and the heart rate of the con- trol group were higher at t2 than at to and t1 （ P 〈 0.05 ）. The changes in systolic blood pressure and heart rate were relatively stable in the trial group. There was no statistical difference in diastolic blood pressure between the two groups. Tracheal intubation condi- tions and the vocal cord visibility of the trial group were better than that of the control group. Conclusion During inducing period of global anaesthesia in children, the combination of entropy index and neuromuscular block monitoring may maintain stable hemody- namic index and provide better tracheal intubation conditions and the vocal cord visibility. It is the best time for tracheal intubation when the range of entropy index is within the range of 40 - 50 and T1 muscle twitch inhibition is more than 90%.