摘要
目的探讨不同脑电双频指数(BIS)下拔除喉罩对全身麻醉患儿呼吸循环功能及苏醒期质量的影响。方法回顾性分析2019年7月至2021年7月安徽省儿童医院收治的80例全身麻醉患儿的临床资料,患儿均采用七氟烷联合瑞芬太尼喉罩全身麻醉,根据拔除喉罩时的BIS范围分为两组,其中A组(55≤BIS<60)42例,B组(60≤BIS≤65)38例。比较两组患儿喉罩插管插入前(T_(0))、插入后即刻(T_(1))、插入后10 min(T_(2))、拔除前即刻(T_(3))、拔除后即刻(T_(4))、拔除后10 min(T_(5))的呼吸循环功能[呼气末二氧化碳分压(P_(ET)CO_(2))、气道压力(PaW)、平均动脉压(MAP)、心率],T_(0)和T_(5)时刻的苏醒期质量[Ramsay镇静(RSS)评分、躁动(RS)评分、观察者警觉/镇静(OAA/S)评分、改良加拿大东安大略儿童医院疼痛评分量表(m-CHEOPS)评分],麻醉效果(麻醉诱导时间、喉罩拔除时间、清醒时间)以及并发症发生情况。结果P_(ET)CO_(2)、PaW、MAP、心率组间和时点间的主效应差异有统计学意义(P<0.01),组间和时点间存在交互作用(P<0.01),在T_(2)、T_(3)时,A组P_(ET)CO_(2)、PaW、MAP、心率均呈升高趋势,B组各时点变化幅度较少,且均低于A组(P<0.05)。RS、OAA/S、m-CHEOPS评分组间和时点间的主效应差异有统计学意义(P<0.01),组间和时点间存在交互作用(P<0.01),T_(5)时两组RSS评分均高于T_(0)时,B组高于A组(P<0.05);T_(5)时两组RS、OAA/S、m-CHEOPS评分均低于T_(0)时,B组RS、m-CHEOPS评分均低于A组,OAA/S评分高于A组(P<0.05)。两组麻醉诱导时间比较差异无统计学意义(P>0.05),B组喉罩拔除时间和清醒时间均短于A组[(7.51±0.78)min比(8.06±0.82)min,(9.13±0.39)min比(9.42±0.43)min](均P<0.01)。拔除喉罩后,B组总并发症发生率低于A组[7.89%(3/38)比26.19%(11/42)](P<0.05)。结论在不同BIS下拔除喉罩对全身麻醉患儿呼吸循环功能及苏醒期质量有不同的影响,BIS为60~65时拔除喉罩可减少患儿呼吸循环功能的波动,苏醒期质量更好,喉罩拔除时间更短,苏醒更快,并发症发生率更低。
Objective To discuss the effects of the laryngeal mask removal under different bispectral indexes(BIS)on respiratory and circulatory function and the awakening quality in children under general anesthesia.Methods A retrospective analysis of clinical data of 80 children under general anesthesia in the Department of Anesthesiology of Anhui Children′s Hospital from Jul.2019 to Jul.2021 was done.All the children were under general anesthesia with sevoflurane combined with remifentanil laryngeal mask,and they were divided into two groups according to the BIS range at mask removal:42 cases in group A(55≤BIS<60)and 38 cases in group B(60≤BIS≤65).The respiratory and circulatory functions[partial pressure of end-tidal carbon dioxide(P_(ET)CO_(2)),airway pressure(PaW),mean arterial pressure(MAP),heart rate],immediately before(T_(0)),immediately after(T_(1)),10 min after(T_(2))laryngeal mask inseration,immediately before(T_(3)),immediately after(T_(4)),and 10 min after(T_(5))laryngeal mask removal of the two groups were compared,and we the quality of the awakening period[Ramsay sedation score(RSS),restlessness score(RS),observer′s assessment of alertness/sedation(OAA/S)score,modified Children′s Hospital of Eastern Ontario pain scale(m-CHEOPS)score],anesthesia effect(anesthesia induction time,laryngeal mask removal time,awakening time)at T_(1)and T_(5),as well as complications were also compared.Results The main effects of P_(ET)CO_(2),PaW,MAP and heart rate were significantly different between groups and time points(P<0.01),and there were interactions between groups and time points(P<0.01).At the moment of T_(2)and T_(3),P_(ET)CO_(2),PaW,MAP,and heart rate in group A tended to increase,and the changes at each time point in group B were less,and all of them were lower than those in group A(P<0.05).The main effects of RS,OAA/S and M-CHEOPS were significantly different between groups and time points(P<0.01),and there were interactions between groups and time points(P<0.01).RSS scores were higher in both groups at the moment of T_(5)than at the moment of T_(0),and higher in group B than in group A(P<0.05);RS scores,OAA/S scores,and m-CHEOPS scores were lower in both groups at the moment of T_(5)than at the moment of T_(0),and RS scores and m-CHEOPS scores in group B were lower than in group A,and OAA/S scores were higher than in group A(P<0.05).There was no statistically significant difference in the induction time of anesthesia between the two group(P>0.05),the mask removal time and awake time in group B were shorter than those in group A[(7.51±0.78)min vs(8.06±0.82)min,(9.13±0.39)min vs(9.42±0.43)min](all P<0.01).After removal of the laryngeal mask,the overall complication rate in group B was lower than that in group A[7.89%(3/38)vs 26.19%(11/42)](P<0.05).Conclusion Removal of laryngeal mask under different BIS values has different effects on respiratory and circulatory function and awakening quality of children under general anesthesia.Removal of mask at BIS values of 60-65 can reduce fluctuation of respiratory and circulatory function of the children,with better quality of awakening period,shorter mask removal time,faster awakening and lower complication rate.
作者
陈高峰
何伟天
CHEN Gaofeng;HE Weitian(Department of Anesthesiology,Anhui Children′s Hospital,Hefei 230022,China)
出处
《医学综述》
CAS
2022年第17期3522-3527,共6页
Medical Recapitulate
关键词
七氟烷
瑞芬太尼
脑电双频指数
喉罩
呼吸循环
苏醒期
Sevoflurane
Remifentanil
Bispectral index
Laryngeal mask
Respiratory and circulatory
Awakening period