右美托咪定联合脑电双频指数监测在小儿全身麻醉清醒拔管中的临床应用

Clinical Application of Dexmedetomidine Combined with EEG Bimodal Index Monitoring on Awake Extubation Under General Anesthesia in Children

目的:探讨右美托咪定联合脑电双频指数监测对全身麻醉患儿苏醒期喉罩拔除时机的指导作用及对患儿并发症发生情况的影响。方法:选取石家庄市第三医院于2018年7月至2020年7月收治的择期行全身麻醉手术的患儿150例,进行脑电双频指数监测,将全部患儿按照随机数字表法分为对照组(75例,脑电双频指数为60~65时拔除喉罩)和观察组(75例,脑电双频指数为75~80时拔除喉罩)。术中对两组患儿应用右美托咪定,比较两组患儿拔管前后的平均动脉压、心率、血氧饱和度(Sp O_2)及收缩压(SBP)水平,观察并记录两组患儿的并发症发生情况,比较两组患儿的总满意度。结果:两组全身麻醉手术患儿术前平均动脉压、心率的差异均无统计学意义(P> 0.05);相较于对照组,观察组全身麻醉手术患儿拔管后的平均动脉压和心率更高,差异均有统计学意义(P <0.05)。两组全身麻醉手术患儿术前Sp O_2、SBP水平和拔管后SBP水平比较,差异均无统计学意义(P>0.05);相较于对照组,观察组全身麻醉手术患儿拔管后的Sp O_2水平更高,差异有统计学意义(P <0.05)。两组全身麻醉手术患儿拔管后的呛咳、屏气、Sp O_2<93%以及喉痉挛等并发症发生率的差异均无统计学意义(P> 0.05)。相较于对照组,观察组全身麻醉手术患儿的总满意度更高,差异有统计学意义(P <0.05)。结论:右美托咪定联合脑电双频指数75~80时拔除喉罩较脑电双频指数60~65时拔除喉罩的效果更佳,在降低并发症发生率、保障拔管期安全性方面具有重要意义。

OBJECTIVE: To probe into the guiding function of dexmedetomidine combined with EEG bimodal index monitoring on awake timing of laryngeal mask removal under general anesthesia and its effect on complications in children. METHODS Totally 150 children undergoing surgery with general anesthesia admitted into the Third Hospital of Shijiazhuang from Jul. 2018 to Jul. 2020 were selected for EGG bimodal index monitoring,all the children were divided into control group( 75 cases,given laryngeal mask removal when EGG bimodal index was 60-65) and observation group( 75 cases,given laryngeal mask removal when EGG bimodal index was 75-80). Dexmedetomidine was applied on both groups during surgery,the mean arterial pressure,heart rate,oxygen saturation( SpO2) and systolic blood pressure( SBP) levels before and after extubation were compared between two groups,the incidences of complications of two groups were observed and recorded,and the overall satisfaction rate were compared between two groups. RESULTS: The differences in mean arterial pressure and heart rate between two groups were not statistically significant( P > 0. 05);compared with the control group,the mean arterial pressure and heart rate of children undergoing general anesthesia after extubation were higher in the observation group,with statistically significant differences( P < 0. 05). There were no statistical significance in differences in the preoperative SpO2,SBP level and SBP level after extubation between two groups of children undergoing surgery with general anesthesia( P > 0. 05);compared with the control group,the SpO2 level of children undergoing surgery with general anesthesia after extubation was higher in the observation group,with statistically significant difference( P < 0. 05). There was no statistical significance in difference in the incidence of complications such as choking,breath-holding,SpO2< 93% and laryngospasm after extubation between two groups of children undergoing surgery with general anesthesia( P > 0. 05).Compared with the control group,the overall satisfaction rate of children undergoing surgery with general anesthesia was higher in the observation group,with statistically significant difference( P < 0. 05). CONCLUSIONS: The effect of laryngeal mask removal under dexmedetomidine combined with EGG bimodal index of 75-80 is better than that of the EEG bimodal index of 60-65,which is of great significance in reducing the incidences of complication and ensuring the safety in extubation period.