中国医科大学学报

中国医科大学学报

中国医科大学学报

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脑电双频指数监测小儿丙泊酚复合瑞芬太尼静脉麻醉维持剂量的临床研究

李真1,2,金宁2,万静洁2,李阳2,万玉骁2,朱俊超2   

  1. 1. 第四军医大学西京医院麻醉科,西安710032;2. 中国医科大学附属盛京医院麻醉科,沈阳110004
  • 收稿日期:2015-05-25 出版日期:2016-01-05 发布日期:2015-12-30
  • 通讯作者: 朱俊超,E-mail:zhujc@sj?hospital.org
  • 作者简介:李真(1990 -),女,医师,硕士研究生.
  • 基金资助:

    国家自然科学基金(81401231)

Clinical Study on the Maintenance Dosage of  Propofol Combined with Remifentanil in Pediatric Patients under BIS Monitoring

LI Zhen1,2,JIN Ning2,WAN Jing-jie2,LI Yang2,WAN Yu-xiao2,ZHU Jun-chao2   

  1. 1. Department of Anesthesiology,Xijing Hospital,The Fourth Military Medical University,Xi′an 710032,China;2. Department of  Anesthesiology,Shengjing Hospital,China Medical University,Shenyang110004,China
  • Received:2015-05-25 Online:2016-01-05 Published:2015-12-30

摘要:

目的 通过脑电双频指数(BIS)监测丙泊酚复合瑞芬太尼小儿静脉麻醉,探索丙泊酚的术中维持剂量。方法 选择全凭静脉麻醉下行小儿扁桃体或腺样体切除术患儿60例,ASA Ⅰ或Ⅱ级。将患儿随机分为P4组(丙泊酚初始剂量4 mg·kg-1·h-1)和P6组(丙泊酚初始剂量6 mg·kg-1·h-1),每组30例。采用BIS监测术中的麻醉深度,根据BIS值(维持在40~60)调整术中丙泊酚的维持剂量,同时将瑞芬太尼的剂量维持在0.05~0.1 μg·kg-1·h-1。分别观察并记录2组丙泊酚剂量调整的次数和累计用量。结果 2组麻醉诱导平稳,无插管反应发生。P4组和P6组麻醉中丙泊酚麻醉维持平均剂量分别为(9.23±2.49)和(11.25±3.17mg·kg-1·h-1结论 应用BIS监测麻醉深度,可减少术中丙泊酚的用量,且诱导、插管、拔管时机的选择更加恰当,血流动力学的波动也更小。应用丙泊酚复合瑞芬太尼(0.05~0.1 μg·kg-1·h-1)全凭静脉麻醉行小儿扁桃体或腺样体切除术,合适的丙泊酚维持剂量为(10.13±2.76mg·kg-1·h-1

关键词: 脑电双频指数, 丙泊酚, 麻醉深度, 儿童

Abstract:

Objective To explore the appropriate clinical maintenance dosage of propofol combined with remifentanil during total intravenous anesthesia in pediatric surgeries. Methods Sixty children with American Society of AnesthesiologistsASAclassorundergoing selective surgeries were randomly allocated to group P4 and group P6 according to the initial dosage of propofol4mg·kg-1·h-16mg·kg-1·h-1)(n =30. Depth of anesthesia was monitored by bispectral indexBIS. The pumping rate of propofol was adjusted according to BIS values40 to 60),as well as maintaining the pumping rate of remifentanil as 0.05 to 0.1μg·kg-1·h-1the times of adjusting the pumping rate of propofol and the cumulating amount of propofol were recorded. Results Both groups had a smooth inductionwithout occurrence of intubation reaction. The average maintenance dosage of propofol of group P4 and group P6 were respectively 9.23±2.49 and 11.25±3.17 mg·kg-1·h-1. Conclusion The cumulating amount of propofol can be properly reduced by using BIS to monitor the depth of anesthesia. In additionthe choice of timing of inductionintubation as well as extubation can be more reasonableand the fluctuation of hemodynamics was found to be smaller. Combined use of propofol6 mg·kg-1·h-1with remifentanil 0.05 to 0.1 μg·kg-1·h-1can lead to much smaller fluctuation of hemodynamics in children under surgeriesand much more stable during the surgeryas well as less adverse effects during the perioperative period.

Key words: bispectral index, propofol, depth of anesthesia, child

中图分类号: 

  • R614.2
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