摘要
目的小儿上肢显微血管外科手术时间长,麻醉深度管理困难。文中观察臂丛神经阻滞复合二异丙酚靶控输注全身麻醉患儿的基本情况,以监测麻醉深度,确定最佳靶浓度与脑电双频指数(bispectral index,BIS)区间。方法将80例手指手术患儿随机分为4组,氯胺酮诱导,臂丛神经阻滞后靶控输注二异丙酚,靶浓度为2.0、2.5、3.0、3.5μg/ml。记录患儿术中体动、血氧饱和度(blood oxygen saturation,SpO2)<95%的次数,术后苏醒时间和恶心呕吐(postoperative nausea andvomiting,PONV)情况及术中相应BIS值。结果 BIS值与二异丙酚的靶控浓度呈良好负相关(P<0.01)。3.0μg/ml组的效应室靶浓度(target effect-site concentration,Ce)达到靶浓度即刻BIS值49±6,效应室浓度稳态后30min BIS值46±5。SpO2<95%例数、术后苏醒时间远低于3.5μg/ml组(P<0.05),术中体动次数较2.0、2.5μg/ml组有显著差异(P<0.05)。术后恶心呕吐4组无明显差异(P>0.05)。结论小儿臂丛神经阻滞复合二异丙酚靶控输注全身麻醉,二异丙酚靶浓度设定为3.0μg/ml,麻醉深度最佳,术后苏醒较快。BIS值维持在40～60之间,有助于麻醉深度的监测。
Objective The pediatric operation of microvascular surgery on upper limb was time-consuming and the anesthe- sia depth was difficult to manage. In this study, the anesthesia depth of children and the clinical effect of bispectral index （BIS） were investigated in pediatric hand operations with brachial plexus block combined with target controlled infusion of propofol. Methods Eighty pediatric patients with fingers surgery were selected and randomly divided equally into four groups. After intramuscular of ket- amine, braehial plexus block was performed with nerve stimulator, and then target controlled infusion of propofol for sedation. The tar- get concentration of propofol was set with 2. O, 2.5 3.0 and 3.5 μg/ml. The BIS score, body movement, times of SpO2 lower than 95%, awaken time and postoperative nausea and vomiting of each child were recorded. Results There is a significant negative cor- relation between BIS score and the target concentration of propofol （ P 〈0. O1 ）. Effect-site concentration of 3.0 p,g/ml group reachedthe target concentration instantly with BIS value of 49 ＋ 6, then remained with BIS value of 46 ± 5 for 30 min in the steady state. Compared with 3.5 g/ml group, significant less times of Sp02 lower than 95%, and shorter postoperative recovery time in 3.0 g/ml group were observed （P 〈 0.05）. We also found less times of body move- ment during operation in 3.0 μg/ml group compared with 2.0 and 2.5 μg/ml group （ P 〈 0.05 ）. No statistical difference on postoperative nausea and vomiting were found between four groups （ P 〉 0.05 ）.Conclusion In pediatric hand operations with brachial plexus block combined with general anesthesia, we may maintain suitable an- esthesia depth if we set the target concentration of propofol as 3.0 μg/ml. And BIS of 40 - 60 can guide the use of propofol, adjust an- esthesia depth, shorten awaken time.
出处
《医学研究生学报》
CAS
北大核心
2013年第4期377-380,共4页
Journal of Medical Postgraduates
基金
济南军区后勤科研项目(CJN090L68)
关键词
脑电双频指数
异丙酚
麻醉深度监测
小儿
手部手术
Bispectral index
Propofol
Pediatric
Anesthesia depth monitoring
Hand operation
