BIS靶控下麻醉对小儿腹腔镜术后苏醒的影响

Effect of endotracheal intubation BIS target controlled intravenous anesthesia on laparoscopic pediatric resuscitation

目的探究气管插管脑电双频指数(BIS)靶控下静脉麻醉对腹腔镜手术小儿苏醒的影响。方法选取2015年7月至2018年7月在武警浙江省总队嘉兴医院就诊并接受腹腔镜手术患儿78例作为研究对象,采用随机数字表法将患儿随机分为试验组和对照组。对照组39例患儿采用不插管丙泊酚静脉注射麻醉,试验组39例患儿采用气管插管BIS靶控丙泊酚静脉麻醉。记录比较两组患儿苏醒时间、拔管时间、麻醉后恢复室(PACU)停留时间等指标,比较两组麻醉效果。结果试验组患儿术后在PACU停留时间明显短于对照组[(20.4±5.3)min vs.(36.2±10.8)min],差异有统计学意义(t=8.966,P<0.05);试验组患儿拔管、苏醒即刻苏醒期躁动量化评分(PAED)评分也明显优于对照组,差异均有统计学意义(t值分别为8.053、9.893,均P<0.05),其苏醒期躁动发生率较对照组明显偏低(7.69%vs. 48.72%),差异有统计学意义(χ^2=16.208,P<0.05);两组患儿麻醉后心率(HR)、收缩压(SBP)、舒张压(DBP)均有所降低,但T1、T2、T3时,对照组患儿HR、SBP、DBP较试验组明显降低(HR:t值分别为2.422、3.328、2.016;SBP:t值分别为4.172、3.278、3.136;DBP:t值分别为2.866、2.238、2.271;均P<0.05)。结论气管插管BIS靶控静脉麻醉用于小儿腹腔镜手术麻醉效果确切,能有效维持患儿血流动力学指标稳定,促进患儿术后苏醒,同时有效减少术后躁动的发生,具有临床应用价值。

Objective To investigate the effect of endotracheal intubation BIS target-controlled intravenous anesthesia on laparoscopic pediatric resuscitation.Methods A total of 78 children who underwent laparoscopic surgery in Jiaxing Hospital of Zhejiang Provincial Armed Police Corps during the period from July 2015 to July 2018 were enrolled as clinical subjects.The children were randomly divided into the experimental group and the control group using the method of random number table.In the control group,39 patients underwent intravenous anesthesia under d propofol with no intubation.In the experimental group,39 patients underwent endovascular intubation with BIS to control propofol intravenous anesthesia.The recovery time,extubation time,post-anesthesia recovery room(PACU) stay time,extubation and wake-up pediatric recovery irritability scale(PAED) scores,as well as agitation during PACU were recorded to compare the effect of anesthesia.Results In the experimental group,the staying time in the PACU was significantly shorter than that in the control group(20.4±5.3 min vs. 36.2±10.8 min) and the difference was statistically significant(t=8.966,P<0.05),and the PAED score of the experimental group was considerably better than that of the control group,and the difference was statistically significant(t=8.053,9.893,respectively,P<0.05 for both).The incidence of agitation during the recovery period was significantly lower than that of the control group(7.69% vs. 48.72%) and the difference was statistically significant(χ^2=16.208,P<0.05).The HR,SBP and DBP were decreased in two groups after anesthesia,but the HR,SBP and DBP in the control group were significantly lower than those in the experimental group at T1,T2,T3(HR:t=2.422,3.328,2.016;SBP:t=4.172,3.278,3.136;DBP:t=2.866,2.238,2.271,respectively;P<0.05 for all).Conclusion Endotracheal intubation BIS target-controlled intravenous anesthesia is effective for pediatric laparoscopic anesthesia.It can effectively maintain the hemodynamic parameters of children,promote postoperative recovery,and effectively reduce the occurrence of postoperative agitation.It possesses a wider clinical application value.