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目的:探讨脑状态指数(CSI)在小儿低温等离子扁桃体切除术中对全凭静脉麻醉深度的监测和调控作用。方法:择期行低温等离子扁桃体切除术的患儿60例,年龄3-7岁,体重12-38kg,ASA I或Ⅱ级,采用随机数字表法,将其分为两组(n=30):对照组(Ⅰ组)和观察组(Ⅱ组),两组均行CSI监测。Ⅰ组采用常规麻醉诱导和麻醉维持方法,Ⅱ组通过维持CSI值于50.02±5.01来调整异丙酚的靶浓度值,其余用药同Ⅰ组。观察记录麻醉诱导前(T0)、插管后1min(T1)、放置开口器时(T2)、扁桃体切除时(T3)、手术结束时(T4)、拔管后10min(T5)的心率(HR)、收缩压(SBP)、舒张压(DBP)和CSI,比较两组异丙酚和瑞芬太尼用量,患儿苏醒、拔管、离开复苏室时间及术中知晓、术后躁动等情况。结果:与T0比较,Ⅰ组HR、SBP、DBP在T1、T2、T3、T4时间点明显降低(P<0.05);与T0比较,Ⅱ组HR在T2、T3、T4时间点明显减少,差异均有统计学意义(P<0.05),在Tl、T5时间点差异无统计学意义(P>0.05),Ⅱ组SBP、DBP在各时间点差异无统计学意义(P>0.05);与Ⅰ组比较,Ⅱ组Tl、T2、T3、T4各时点的HR、SBP、DBP、CSI值明显升高,而异丙酚用量较少,苏醒、拔管和离开复苏室时间缩短,组间比较差异有统计学意义(P<0.05);两组患儿T0、T5时点的HR、SBP、DBP、CSI差异无统计学意义(P>0.05);两组患儿均无术中知晓,术后躁动等并发症比较差异无统计学意义(P>0.05)。结论:通过CSI监测为小儿全凭静脉麻醉的麻醉深度提供量化指标,可避免麻醉过深、减少异丙酚用量、缩短复苏时间、防止术中知晓。
Objective: To investigate the effect of brain state index (CSI) on the depth of total intravenous anesthesia in pediatric low-temperature plasma tonsillectomy. Methods: Sixty children (aged 3-7 years old, weighing 12-38 kg) with ASA I or II were randomly divided into two groups (n = 30) by random number table: The control group (group Ⅰ) and observation group (group Ⅱ), both groups underwent CSI monitoring. In group Ⅰ, conventional anesthesia induction and anesthesia maintenance were used. In group Ⅱ, the target concentration of propofol was adjusted by maintaining the value of CSI at 50.02 ± 5.01. The heart rate (HR) before anesthesia induction (T0), intubation 1 minute (T1), opener (T2), tonsillectomy (T3), operation end (T4) ), Systolic blood pressure (SBP), diastolic blood pressure (DBP), and CSI. The effects of propofol and remifentanil on both groups were compared between the two groups in terms of recovery time, extubation time, intraoperative awareness and postoperative agitation . Results Compared with T0, HR, SBP and DBP in group Ⅰ were significantly decreased at T1, T2, T3 and T4 (P <0.05). Compared with T0, HR in group Ⅱ was significantly decreased at T2, T3 and T4 (P <0.05). There was no significant difference at Tl and T5 (P> 0.05). There was no significant difference in SBP and DBP between two groups at each time point (P> 0.05) In group Ⅱ, the HR, SBP, DBP and CSI of Tl, T2, T3 and T4 in group Ⅱ were significantly higher than those in group Ⅱ, while the dosage of propofol was less, the time of waking up, extubating and leaving the recovery room was shortened, (P <0.05). There was no significant difference in HR, SBP, DBP and CSI between the two groups at T0 and T5 (P> 0.05). There was no significant difference between the two groups Post-agitation and other complications no significant difference (P> 0.05). CONCLUSIONS: To provide quantitative indicators of the depth of anesthesia in children with total intravenous anesthesia through CSI monitoring can avoid over-anesthesia, reduce the dosage of propofol, shorten the recovery time and prevent intraoperative awareness.