不同浓度七氟烷对患儿全麻诱导期癫痫样放电的影响

Effects of different concentrations of sevoflurane on epileptic discharge during general anesthesia induction in children

目的探讨不同浓度七氟烷对患儿全麻诱导期癫痫样放电的影响。方法选择择期全麻下行扁桃体和/或腺样体摘除术患儿66例,年龄3~12岁,ASA分级Ⅰ或Ⅱ级,性别不限,采用随机数字表法分为4%七氟烷组(L组)、6%七氟烷组(M组)和8%七氟烷组(H组),每组22例。术中采用全凭静脉麻醉。记录诱导期癫痫样放电和苏醒期谵妄的发生情况。采用χ^(2)检验对癫痫样放电与苏醒期谵妄进行相关性分析。结果与L组比较,H组兴奋型癫痫样放电发生率降低,M组和H组癫痫样放电发生率降低(P<0.05);M组和H组兴奋型癫痫样放电和癫痫样放电发生率差异无统计学意义(P>0.05);3组抑制型癫痫样放电和苏醒期谵妄发生率差异无统计学意义(P>0.05)。癫痫样放电、兴奋型癫痫样放电的发生与苏醒期谵妄的发生具有相关性(P<0.05),抑制型癫痫样放电的发生与苏醒期谵妄的发生无相关性(P>0.05)。结论低浓度(4%)七氟烷可导致患儿全麻诱导期兴奋型癫痫样放电增加。

Objective To investigate the effects of sevoflurane at different concentrations on epileptic discharge during general anesthesia induction in children.Methods Sixty-six pediatric patients of both sexes,aged 3-12 yr,of American Society of Anesthesiologists physical statusⅠorⅡ,undergoing elective tonsillectomy or(and)adenoidectomy under general anesthesia,were divided into 3 groups(n=22 each)using a random number table method:4%sevoflurane group(L group),6%sevoflurane group(M group)and 8%sevoflurane group(H group).Combined intravenous-inhalational anesthesia was used during operation.The occurrence of epileptiform discharge during induction period and delirium during emergence was recorded.The correlation between epileptiform discharge and delirium during emergence was analyzed usingχ^(2) test.Results Compared with group L,the incidence of excitatory epileptiform discharge was significantly decreased in group H,and the incidence of epileptiform discharge was significantly reduced in group M and group H(P<0.05).There was no significant difference in the incidence of excitatory epileptiform discharge and epileptiform discharge between group M and group H(P>0.05).There was no significant difference in the incidence of inhibitory epileptiform discharge and delirium during emergence among the three groups(P>0.05).The occurrence of epileptiform discharges and excitatory epileptiform discharges was correlated with the occurrence of delirium during emergence(P<0.05),and the occurrence of inhibitory epileptiform discharges was not correlated with the occurrence of delirium during emergence(P>0.05).Conclusion Low concentration(4%)of sevoflurane can lead to an increase in excitatory epileptiform discharges during emergence from general anesthesia in children.