依托咪酯用量对左向右分流先天性心脏病患儿血流动力学及脑电双频指数的影响

Correlation of etomidate and bispectral index in anesthesia induction of children with congenital heart disease shunting from left to right

目的·分析左向右分流先天性心脏病患儿连续泵注依托咪酯镇静时剂量与脑电双频指数(BIS)的相关性。方法·24例左向右分流先天性心脏病患儿全身麻醉诱导后停止吸入七氟醚,使BIS值逐渐恢复至80;经外周静脉按0.3 mg/(kg·min)剂量持续泵注依托咪酯,待BIS值为40时停止泵入;记录期间BIS为80、70、60、50和40时心率(HR)、动脉压(ABP)和中心静脉压(CVP)的变化及依托咪酯总的用量,分析左向右分流先天性心脏病患儿连续泵注依托咪酯镇静时剂量与BIS的相关性。结果·依托咪酯持续泵注至BIS值达到40时,患儿血流动力学变化不明显,依托咪酯与BIS值呈负相关(r=-0.769,P<0.01);2岁以下先天性心脏病患儿依托咪酯平均剂量高于2岁以上先天性心脏病患儿(P=0.034)。结论·依托咪酯对左向右分流先天性心脏病患儿血流动力学的影响较小,泵注剂量与BIS值呈负相关;左向右分流先天性心脏病患儿BIS与年龄可能有一定关系。

Objective·To explore the correlation of etomidate dose and bispectral index （BIS） in children with congenital heart disease shunting from left to right during anesthesia induction. Methods·After general anesthesia induction to 24 children with congenital heart disease shunting from left to right, sevoflurane inhaling was stopped in order to make the BIS value gradually return to 80. Intravenous injection of etomidate was sustained by 0.3 mg/（kg·min） until the BIS value reached 40. The heart rate （HR）, arterial blood pressure （ABP） and central venous pressure （CVP） of the patients were recorded when BIS value was 80, 70, 60, 50,and 40, respectively.The correlation of etomidate dose and BIS value in the children during anesthesia induction was analyzed. Results·There were no significant hemodynamic changes when the BIS value were from 80 to 40. The amount of etomidate was highly negatively correlated with the BIS value （r=-0.769, P〈0.01）, the average dose of etomidate in children under 2 years of age was significantly higher than that in children over 2 years old （P=0.034）. Conclusion·The etomidate dose is highly negatively correlated with the BIS value. Etomidate has less influence on hemodynamic parameters of children with congenital heart disease shunting from left to right. The BIS value may have relationship with patients＇age.