摘要【目的】 探讨脑电双频指数(BIS)监测下不同麻醉深度对全麻患儿机体应激反应、循环系统及术后认知功能的影响。【方法】按照入院先后顺序将150例择期全身静脉麻醉手术患儿分为A、B两组,A组术中维持BIS值40~50,B组术中维持BIS值<50~60,比较两组不同时间点血流动力学、应激反应指标及简易智能量表评分(MMSE)和麻醉效果。【结果】两组围术期心率(HR)、平均动脉压(MAP)比较差异均无显著性( P >0.05);A组术毕(T3)、术后1 d(T5)血浆内皮素-1(ET-1)、促肾上腺皮质激素(ACTH)、C反应蛋白(CRP)水平均显著低于B组( P <0.05);两组术后24 h MMSE评分较术前1 h均显著下降( P <0.05),但两组组间不同时间点MMSE评分比较差异无显著性( P >0.05);两组均无明显不良反应发生。【结论】BIS监测下不同麻醉深度均能有效维持全身静脉麻醉患儿血流动力学稳定,不同麻醉深度对患儿认知功能的影响类似,但BIS值40~50相比<50~60对机体的应激反应影响较轻。
Abstract：【Objective】 To investigate the effect of different depths of anesthesia under bispectral index (BIS) monitoring on stress response, circulatory system and postoperative cognitive function in children receiving general anesthesia. 【Method】 One hundred and fifty cases of children undergoing elective operation under total intravenous anesthesia were divided into group A and group B. The BIS value in the group A was maintained at 40~50 while that in the group B was maintained at < 50~60. The hemodynamic indexes, stress reaction indexes ,MMSE and anaenf esthesia effect at different time points were compared between the two groups. 【Results】At time of completing operation(T3) and 1 day after operation(T5), there was no significant difference in heart rate (HR) and mean arterial pressure (MAP) between the two groups ( P > 0.05). The levels of plasma endothelin-1 (ET-1) and adrenocorticotropic hormone (ACTH), C-reactive protein (CRP) in the group A were significantly lower than those in the group B ( P < 0.05). The scores of MMSE at 24 hours after operation in both groups were significantly lower than those at 1 hour before operation ( P < 0.05), but there was no significant difference in MMSE scores between the two groups at different time points ( P > 0.05), and no significant adverse reactions occurred in both groups.【Conclusion】The hemodynamic stability of children with general intravenous anesthesia is effectively maintained under different anesthetic depths monitored by BIS. The effects of different anesthetic depths on cognitive function of children are similar, but the effect of BIS 40~50 on stress response is less than that of < 50~60.
欧明灵. 不同麻醉深度对全麻儿童机体应激损伤、循环系统及术后认知功能的影响[J]. 医学临床研究, 2018, 35(7): 1268-1270.
OU Ming-ling. Effects of Different Anesthetic Depths on Stress Injury, Circulatory System and Postoperative Cognitive Function in Children under General Anesthesia. JOURNAL OF CLINICAL RESEARCH, 2018, 35(7): 1268-1270.
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2018, Vol. 35 
