脑电双频指数调控下的全凭静脉麻醉在小儿腹腔镜手术中的应用

摘要

Objective To study the feasibility of bispectral index-guided intravenous anesthesia with propofol in laparoscopic surgery in children. Methods Totally 40 male children scheduled for laparoscopic surgery were divided into two groups randomly. Group Ⅰ was anesthetized with bispectral index-guided intravenous anesthesia with propofol and group Ⅱ was anesthetized with continuous infusion of propofol. The dosage of anesthetic, hemodynamic index, blood gas and extubation time were compared. The plasma concentrations of cortisol, norepinephrine, epinephrine and adrenocorticotropic hormone at different time points during the operation were tested. Results The dosage of propofol in group Ⅰ was lower than that in group Ⅱ (110.0 ± 7.2 vs. 131.0 ± 8.5, P<0.05). Extubation time was shorter in group Ⅰ than in group Ⅱ (8.2 ± 2.1 vs. 13.4 ± 4.3, P<0.05). The patients' heart rate and mean arterial pressure during intubation and before pneumoperitoneum in group Ⅰ were lower than those in group Ⅱ (P<0.05). Hemodynamic index between the two groups at the other time points did not differ significantly. There was no significant difference in blood gas at different time points. The patients' plasma concentrations of cortisol, norepinephrine, epinephrine and adrenocorticotropic hormone during intubation and before pneumoperitoneum were lower in group I than in group Ⅱ (P<0.05), but had no significant difference at the other time points. Conclusion BIS monitoring can reduce the amount of propofol, shorten the time of extubation in children, maintain hemodynamic stability, and reduce the stress response. Application of bispectral index-guided intravenous anesthesia in laparoscopic surgery in children is feasible.%目的 探讨脑电双频指数(BIS)调控丙泊酚静脉麻醉在小儿腹腔镜手术中应用的可行性.方法 择期行腹腔镜手术的男性患儿40例,随机分为BIS调控丙泊酚静脉麻醉组(Ⅰ组)和丙泊酚持续泵入组(Ⅱ组),比较两组术中麻醉药用量、血流动力学、血气变化及拔管时间；检测两组术中不同时点血浆皮质醇(Cor)、去甲肾上腺素(NE)、肾上腺素(E)、促肾上腺皮质激素( ACTH)的水平.结果 Ⅰ组丙泊酚用量明显低于Ⅱ组[(110.0±7.2)μg/(kg·min) vs.(131.0±8.5)μg/(kg·min),p＜0.05],拔管时间短于Ⅱ组[8.2±2.1]min vs.(13.4±4.3)min,P＜0.05]；Ⅰ组心率(HR)、平均动脉压(MAP)在插管时、气腹前两个时点低于Ⅱ组(P＜0.05),余各时点血流动力学差异无统计学意义；血气变化各时点差异无统计学意义；Ⅰ组Cor、NE、E、ACTH水平在插管时、气腹前两个时点低于Ⅱ组(P＜0.05),余各时点上述各指标差异无统计学意义.结论 BIS监测可减少丙泊酚用量并缩短患儿拔管时间,维持血流动力学稳定,降低应激反应,在小儿腹腔镜手术中的应用是可行的.