摘要
目的观察将Marsh成人药代参数靶控输注异丙酚用于小儿术中镇静的安全性和可行性,评价脑电双频指数(BIS)与镇静程度的相关性。方法选择ASAⅠ级无神经精神系统疾患择期行腹股沟斜疝修补术小儿20例,所有患者术前均不用镇静药。常规监测血压、心电图、脉搏血氧饱和度(SpO2),连接脑电监护仪监测BIS。用TCI技术输注异丙酚镇静,用镇静警醒评分(OAA/S)评价镇静程度。充分镇静后,实施骶管或硬膜外阻滞。记录不同时点的血压、心率、BIS、OAA/S、丙泊酚预期理论浓度(Cp)以及诱导时间、苏醒时间、丙泊酚用量及并发症。结果平均诱导时间为(即清醒至OAA/S≤1)(302.6±60)s,相应BIS为66±10;靶控后恢复时间(即停药至OAA/S≥2)(14.6±3.3)min,相应BIS为86.2±6.0;异丙酚诱导剂量(1.9±0.7)mg/kg,异丙酚维持剂量(8.3±3.3)mg·kg-1·h-1,异丙酚目标浓度保持在2～3mg/L,术中BIS值保持在62±11。诱导及维持中血压、心率稳定,未出现呼吸抑制(SpO2≥95%)。BIS与镇静评分的相关性较好。结论Marsh成人药代参数靶控输注异丙酚用于小儿术中镇静安全有效,BIS是较好的镇静程度监测指标。
Objective To validate the efficacy and safety of propofol sedation via TCI during epidural anesthesia or sacral block in children and to evaluate the use of BIS as a tool for measuring the depth of sedation. Methods Twenty children scheduled for elective inguinal hernia repair （ ages 4 - 10 yr, ASA grades I , with no neurological or psychological disorders）were enlisted in the study. Sedation was solely maintained with TCI propofol, the TCI device was programmed with Marsh adult pharmcokinetic model; other sedatives were avoided. The infusion was adjusted till an adequate sedation （ OAA/S ≤ 1 ） was secured before the start of sacral or epidural block. The course of propofol infusion was closely observed, with the BIS, OAA/S, Cp （predicted blood propofol concentration）, vital signs etc. being monitored. Results The mean induction time （ the time needed to achieve an OAA/S ≤ 1 ） was （302.6 ± 60） s, the corresponding BIS was 66 ± 10. The recovery time after the withdrawal of propofol was （ 14.6 ± 3.3 ） min, the BIS when patient was considered to become awake（ OAA/S ≥ 2） was 86.2 ± 6.0. The induction dose of propofol was （ 1.9 ± 0.7 ） mg/kg, the maintenance dose of propofol was （ 8.3 ± 3.3 ） mg · kg^- 1 · h^- 1, the predicted blood propofol concentration was 2 - 3 mg/L. The BIS was 62 ± 11 during the operation. Heart rate and blood pressure were stable throughout the procedure, with no episodes of apnea encountered. The BIS was well correlated with the sedation score. Conclusion Propofol sedation via TCI programmed with Marsh adult pharmacokinetic parameters is safe and effective during pediatric surgery. BIS is an index reliable to guide the depth of sedation.
出处
《徐州医学院学报》
CAS
2008年第1期8-10,共3页
Acta Academiae Medicinae Xuzhou
关键词
靶控输注
异丙酚
脑电双频指数
镇静警醒评分
小儿
target - controlled infusion
propofol
bispectral index （BIS）
OAA/S
children
