Hu Jing,Hua Lei,Huo Lianghong,et al.Analysis of influencing factors of adequate anesthesia time ratio of closed-loop infusion of propofol in children[J].Journal of Clinical Pediatric Surgery,2021,20(05):458-463.[doi:10.12260/lcxewkzz.2021.05.012]
儿童闭环靶控丙泊酚输注充分麻醉时间比的影响因素分析
- Title:
- Analysis of influencing factors of adequate anesthesia time ratio of closed-loop infusion of propofol in children
- 关键词:
- 闭环靶控技术; 二异丙酚/投药和剂量; 麻醉/方法; 儿童
- 分类号:
- R726;R614
- 摘要:
- 目的 初步探讨儿童丙泊酚闭环靶控输注技术（closed-loop target-controlled infusion technology，CL-TCI）充分麻醉时间比[bispectral index （40~60）%，BIS （40~60）%]的影响因素，对可能出现低BIS （40~60）%的患者采取更严密的监测，确保丙泊酚CL-TCI技术的安全使用。方法 以首都医科大学附属北京儿童医院择期行非颅脑全麻手术患者152例（有效样本量136例）为研究对象，年龄12~216个月，美国医师协会麻醉分级（American Society of Anesthesiologists，ASA）Ⅰ~Ⅳ级。予以丙泊酚TCI （paedfusor模型）2~4 μg/mL、芬太尼2 μg/kg静脉输注以及罗库溴铵1 mg/kg静脉推注诱导。当BIS数值低于60并维持30 s时认为诱导结束。根据目标血压调整瑞芬太尼用量，手术完毕时停药。记录维持期BIS （40~60）%以及患者性别、体温、月龄、身体质量指数（body mass index，BMI）、ASA分级、麻醉时间、出血量。结果 ASA分级和月龄是BIS （40~60）%的影响因素，其中以ASA分级影响最为显著，回归方程为Y=71.72+0.15×月龄-6.82×ASA，R2=0.53。月龄决策树中，年龄拆分值为17个月。结论 丙泊酚CL-TCI技术中，术前ASA分级及低龄是导致BIS （40~60）%降低的危险因素，其中ASA分级对BIS （40~60）%影响更大。对于ASA Ⅲ级以上或17月龄以下的患者，应加强术中镇静深度的观察与调控。
- Abstract:
- Objective To explore the influencing factors of adequate anesthesia time ratio (BIS40-60%) during CL-TCI infusion and adopt more rigorous monitoring for children with possible low BIS40-60%.Methods American Society of Anesthesiologists physical status Ⅰ~Ⅳ children (12-36 months,male=female=38;37-216 months,male=female=38) undergoing elective non-craniocerebral general anesthesia were included.Propofol was delivered through a closed-loop anesthesia delivery system.The target bispectral index (BIS) value was set at 50 during maintenance anesthesia.BIS40-60%,gender,body temperature,age,BMI,ASA grading,anesthesia duration and blood loss were recorded.Results Both ASA grade and age affected BIS 40-60% and the impact of ASA grade was more obvious.The regression equation was 71.72+0.15*month-6.82*ASA,R2=0.53.And 17 month was the age split value in month age decision tree.Conclusion As for propofol CL-TCI technology,preoperative ASA grade and young age are the risk factors leading to a 40-60% reduction in BIS and ASA grade has a greater impact on the stability of the system.For ASA Ⅲ magnitude or age 17 months or under,children should be closely observed for intraoperative sedation depth and regulation.
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备注/Memo
收稿日期:2020-10-24。
基金项目:吴阶平医学基金会临床科研专项资助基金（编号：320.6750.19089-102）
通讯作者:张建敏:Email:zjm428@sina.com