脑电双频指数监测在危重症患儿电子支气管镜术中的应用

Application of bispectral index monitoring in critical children with electronic bronchoscopy

摘要:

目的 探讨脑电双频指数（BIS）监测应用于儿童重症监护病房（PICU）患儿行电子支气管镜术的临床价值。方法 选取河南省儿童医院PICU收治的患有呼吸系统疾病的患儿107例，均符合行电子支气管镜术指征，随机分为对照组（51例）和观察组（56例）。两组患儿在行电子支气管镜术的过程中，均给予心电监护、舒芬太尼联合丙泊酚镇痛镇静。对照组以临床经验判断麻醉深浅程度指导用药；观察组持续行BIS监测，根据BIS监测数值判断麻醉深浅程度并指导用药。记录两组患儿术前、术中及操作结束后的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO₂），比较两组患儿术后苏醒时间及呛咳呕吐等不良反应发生率的情况。结果 观察组在T₁、T₂时间点SpO₂明显高于对照组（P < 0.05），术后苏醒时间短于对照组，不良反应发生率低于对照组（P < 0.05）；观察组因低氧血症导致的操作中断、引起二次进镜操作的发生率明显低于对照组（P < 0.05），在丙泊酚药物用量上，观察组也少于对照组（P < 0.05）。结论 在危重症患儿行电子支气管镜术中，BIS监测能够有效监测患儿的麻醉深浅程度，降低不良反应发生率，保障患儿能够安全顺利地完成电子支气管镜术。

Abstract:

Objective To explore the clinical value of bispectral index (BIS) monitoring in children with electronic bronchoscopy in pediatric intensive care unit (PICU).Methods 107 children with respiratory diseases were selected for electronic bronchoscopy. Randomly divided into control group (51 cases) and observation group (56 cases). Two groups were given ECG monitoring, sufentanil combined with propofol for analgesia and sedation in the process of electronic bronchoscopy.Judging the degree of anesthesia by the clinical experience in the control group, the observation group judged by BIS. Record the heart rate, mean arterial pressure and blood oxygen saturation of two groups before, during and after the operation. Comparing the postoperative recovery time and the incidence of adverse reactions of coughing and vomiting between the two groups.Results The SpO₂ of the observation group was significantly higher than that in the control group at T₁ and T₂ (P < 0.05). The postoperative recovery time and the incidence of adverse reactions of the observation group were lower than those in the control group (P < 0.05). The incidence of interruption operation and the second operation of the observation group was significantly lower than that in the control group, duing to hypoxemia (P < 0.05).Conclusion BIS can effectively monitor the depth of anesthesia in critical children with electronic bronchoscopy, complete the diagnosis and treatment of electronic bronchoscopy, reduce the incidence of adverse reactions.