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脑干听觉诱发电位用于监测小儿麻醉深度及苏醒的临床研究

[Clinical study on applying brainstem auditory evoked potential to monitor anesthesia depth and awaken in children].

作者信息

Chen Ya-qiu, Li Nai-lin, Liu Hong, Hu Jia-qiang, Wang Da-zhu

机构信息

Department of Otorhinolaryngology, Tianjin Children's Hospital, Tianjin 300074, China.

出版信息

Zhonghua Er Bi Yan Hou Ke Za Zhi. 2003 Apr;38(2):118-20.

Abstract

OBJECTIVES

To study applying auditory brainstem reaction (ABR) to monitor the general anesthesia depth and awaken degree in children as an objective guide.

METHODS

Forty-five infant or children patients, American Society of Anesthesiologists(ASA) graded I-II, with normal audition, were selected and divided into 3 groups (15 cases per group) to receive propofal venous anesthesia, fentanyl venous anesthesia, or isoflurane anesthesia, respectively. During anesthesia, peak latencies (PL) of I, III, V wave, and interpeak latencies (IPL) of I-III, III-V, I-V were monitored and recorded after short sound stimulation of 90 db which accumulated 1,000 times with Madsen. The changing of PL and IPL with time passing and anesthesia dosage was studied to discuss the feature of ABR in each anesthesia procedure as above.

RESULTS

There is a significant positive correlation between PL and IPL of ABR waves as above and the dosage of propofol or the concentration of isoflurane. The dosage or the concentration increased, and PL and IPL prolonged. It is important of PL of wave I to reflect anesthesia degree. It is wave V with the best stability and correlation to monitor anesthesia degree. After anesthesia period or patients almost awaken, PL and IPL of some ABR waves were still more than normal values, which is detention reaction. For the fentanyl anesthesia, ABR is not sensible enough, i.e. has little correlation.

CONCLUSION

The changing of PL and IPL of ABR waves could conclude anesthesia degree in children and be treated as reference of whether awaken or not in some certain, but have possibility of detention reaction.

摘要

目的

研究应用听觉脑干反应(ABR)监测小儿全身麻醉深度及苏醒程度,作为一种客观指导。

方法

选择45例美国麻醉医师协会(ASA)分级为I-II级、听力正常的婴幼儿或儿童患者,分为3组(每组15例),分别接受丙泊酚静脉麻醉、芬太尼静脉麻醉或异氟烷麻醉。麻醉期间,用Madsen对90分贝短声刺激累计1000次后,监测并记录I、III、V波的峰潜伏期(PL)以及I-III、III-V、I-V的峰间潜伏期(IPL)。研究PL和IPL随时间及麻醉剂量的变化,以探讨上述各麻醉过程中ABR的特征。

结果

上述ABR波的PL和IPL与丙泊酚剂量或异氟烷浓度之间存在显著正相关。剂量或浓度增加,PL和IPL延长。I波的PL对反映麻醉程度很重要。V波监测麻醉程度的稳定性和相关性最佳。麻醉期后或患者接近苏醒时,部分ABR波的PL和IPL仍高于正常值,即存在延迟反应。对于芬太尼麻醉,ABR不够敏感,即相关性小。

结论

ABR波的PL和IPL变化可判断小儿麻醉程度,并在一定程度上作为是否苏醒的参考,但存在延迟反应的可能性。

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