脑电双频指数监测下盐酸右美托咪定预注在小儿无痛支气管镜诊疗中的价值研究

Study on the value of Dex pre-injection under the EEG BIS monitoring in diagnosis and treatment with painless bronchoscopy on children

目的:探讨脑电双频指数(BIS)监测下盐酸右美托咪定(Dex)预注在小儿无痛纤维支气管镜诊疗中的价值。方法:选取医院收治的拟在内镜中心接受无痛支气管镜检查的100例患儿,将检查时预注Dex的患儿纳入Dex组,将未预注Dex的患儿纳入对照组,每组50例。Dex组术前15 min给予Dex 0.75μg/kg静脉泵入,对照组给予等量生理盐水静脉泵入,两组患儿均使用丙泊酚、舒芬太尼诱导,置入喉罩辅助通气,术中吸入七氟烷维持麻醉。Dex组同时采用脑电双频谱指数(BIS)进行麻醉深度监测,BIS<60时开始手术,术中维持BIS范围40~60;对比两组患儿心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_(2))、pH值的变化,对比两组的手术操作时间、麻醉时间、苏醒时间、丙泊酚用量及相关不良反应发生率。结果:在通过声门时、检查结束后5 min,Dex组的HR、MAP测定值均低于对照组,差异具有统计学意义(t_(通过声门时)=-3.381,t=-3.943;t_(检查结束后5 min)=-2.652,t=-2.462;P<0.05);Dex组和对照组患儿检查前、通过声门时、检查结束时的OAA/S评分及操作时间比较,差异均无统计学意义;Dex组的麻醉时间、苏醒时间及丙泊酚用量均低于对照组,差异具有统计学意义(t=-2.468,t=-6.136,t=-3.889;P<0.05);Dex组的麻醉相关不良反应发生率低于对照组组,差异具有统计学意义(χ^(2)=5.263,P<0.05)。结论:小儿无痛支气管镜诊疗中应用BIS监测下Dex预注在维持患儿的血流动力学稳定,减少麻醉药物用量及降低麻醉相关不良反应发生率中具有良好效果。

Objective:To explore the value of dexmedetomidine(Dex)pre-injection under the monitoring of bispectral index(BIS)of electroencephalograph(EEG)in the diagnosis and treatment with painless fiber bronchoscopy on children.Methods:100 children who prepared to underwent painless bronchoscopy examination in endoscope center of hospital were selected,and they were divided into Dex group and control group according to whether received Dex pre-injection,with 50 cases in each group.Dex group received Dex as 0.75μg/kg dose at the 15th min before surgery,and control group received equivalent normal saline.And both two groups adopted propofol and sufentanil as induction,and implanted laryngeal mask to assist ventilation,and inhaled sevoflurane to maintain anesthesia in surgery.Dex group adopted EEG BIS to monitor the degree of anesthesia at the same time,and the surgery was conducted when BIS was less than 60,and the BIS range should be maintained between 40-60 in surgery.The changes of heart rate(HR),mean arterial pressure(MAP),blood oxygen saturation(SpO_(2)),pH value between two groups were compared,and the operating time,anesthesia time,awakening time,propofol dosage and the incidence of related adverse events between two groups were further compared.Results:Both HR and MAP of Dex group were significantly lower than those of control group when passing glottis and at the 5th min after the examination completed(t_(passing glottis)=-3.381,t=-3.943,t_(at the 5th min after the examination completed)=-2.652,t=-2.462,P<0.05),respectively.The differences of Modified Observer’s Assessment of Alert/Sedation(OAA/S)score and operating time before examination,when passing glottis and at the time of completing examination between Dex group and control group were not significant.The time of anesthesia,awakening time and propofol dosage in Dex group were significantly lower than those in control group(t=-2.468,t=-6.136,t=-3.889,P<0.05),respectively.The incidence of anesthesia-related adverse reactions in Dex group was significantly lower than that in control group(χ^(2)=5.263,P<0.05).Conclusion:In diagnosis and treatment with painless bronchoscopy on children,the Dex pre-injection under BIS monitoring has favorable effect in maintaining hemodynamics stability,and reducing the dosage of anesthetics and the incidence of anesthesia-related adverse events.