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目的观察小儿丙泊酚镇静状态下在不同BIS值拔出气管插管时的血流动力学变化及麻醉并发症,选择最佳拔管时机的BIS值。方法选择全麻患儿200例,随机分为A组(拔管时BIS值60～65)、B组(拔管时BIS值～70)、C组(拔管时BIS值～75)、D组(拔管时BIS值～80),每组50例。全部患儿依次静注阿托品、芬太尼、丙泊酚、罗库溴铵麻醉诱导,术中持续静注丙泊酚、瑞芬太尼麻醉,维持术中BIS值45～55。术毕无吸痰等外界刺激情况下,各组在不同BIS值下吸痰拔管,观察并记录各组患儿的血流动力学变化、术后并发症及清醒时间。结果 A组舌后坠发生率(24%)、呼吸抑制发生率(44%)明显高于其他3组(P﹤0.05),而D组患儿躁动发生率(38%)、恶心呕吐发生率(14%)最高。B、C组患儿血流动力学反应轻,呼吸系统影响小,术后麻醉并发症少。结论在镇痛充分的前提下,丙泊酚镇静拔管时BIS值66～75范围内拔管较为适宜;BIS值71～75范围内拔管最为安全平稳。
Objective To observe the hemodynamic changes and anesthesia complications of pediatric propofol sedation under different BIS values after intubation, and select the best BIS value for the timing of extubation. Methods Totally 200 children with general anesthesia were randomly divided into group A (BIS value 60 ~ 65 during extubation), group B (BIS value ~ 70 during extubation), group C (BIS value ~75 during extubation), D Group (extubation BIS value ~ 80), 50 cases in each group. All children were followed by intravenous injection of atropine, fentanyl, propofol, rocuronium induction of anesthesia, intraoperative continuous intravenous propofol, remifentanil anesthesia, to maintain intraoperative BIS value of 45 to 55. No sputum and other external stimuli, the group under different BIS value suction sputum extubation, observed and recorded in each group hemodynamic changes, postoperative complications and awake time. Results The incidence of tongue trauma (24%) and respiratory depression (44%) in group A were significantly higher than those in other three groups (P <0.05), while the incidence of agitation (38%) and the incidence of nausea and vomiting (14%) highest. B, C group hemodynamics in children with mild respiratory effects, less postoperative complications of anesthesia. Conclusion Under the premise of adequate analgesia, extubation of propofol with BIS values of 66-75 is more appropriate for extubation; extubation of BIS values of 71-75 is the safest and most stable.