儿童全凭静脉麻醉在脑电双频指数指导下气管拔管的临床观察

Clinical Observation of Bispectral Index in Evaluation of the Indications of Extubation in Children′s Total Intravenous Anesthesia

目的 观察小儿全凭静脉麻醉手术结束后在不同脑电双频指数（BIS）值拔出气管插管时的血流动力学变化及麻醉并发症,选择最佳拔管时机的BIS值。方法 选择全麻患儿180例,随机分为A组（拔管时BIS值：56~60）、B组（拔管时BIS值：61~65）、C组（拔管时BIS值66~70）、D组（拔管时BIS值：71~75）、E组（拔管时BIS值：76~80）、F组（拔管时BIS值：81~85）,每组30例。全部患儿依次静注芬太尼、丙泊酚、顺苯磺酸阿曲库铵诱导,术中持续静注丙泊酚、瑞芬太尼麻醉,维持术中BIS值40~55。术毕各组在不同BIS值下吸痰拔管,观察并记录各组患儿血流动力学变化、脉搏血氧饱和度、术后并发症及清醒时间。结果A、B组深麻醉拔管,循环稳定,但不良反应发生率高,清醒时间长。E、F组在清醒时拔管,刺激较大,极易躁动。C、D组患儿血流动力学反应轻,呼吸系统影响小,术后麻醉并发症少。结论 儿童全凭静脉麻醉拔管时BIS值在66~75范围内拔管较为适宜,BIS值71~75范围内拔管最为安全平稳。

Objective To evaluate the value of bispectral index （BIS） monitoring as an indicator for extubation sedation level after children＇s oper- ation by total intravenous anesthesia. Methods One hundred and eighty children （2-13 years old） were randomly divided into six groups with 30 cases in each. Group A kept BIS 56-60, and Group B 61-65, Group C 66-70, Group D 71-75, Group E 76-80, Group F 81-85 fill extubation. All children were given fentanyl,propofol and cisatmcurium besilate when induced,and maintained with propofol and remifentanil. All cases kept BIS 40- 55 during the operation. Then the changes of electrocardiogram, mean arterial pressure, heart rate, SpO2, postoperative complications and recovery time were observed. Results Groups A and B were extubated at deep anesthesia, cycle stability, but with high incidence of adverse reactions and awaked with a long time. Groups E and F were extubated when awaked, but with greater stimulation and easier agitation. Groups C and D were lighter hemodyrramic responses, less respiratory effects and less postoperative comphcafions of anesthesia. Conclusion The BIS level of 66-75 is a good se- dation level for extubation, especially in the level of 71-75.