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目的比较脑电双频谱指数(BIS)监测下小儿食管引流型喉罩(PLMA)置入和气管内插管所需的七氟烷呼气末浓度和最低肺泡有效浓度(MAC)值。方法择期行下腹部短小手术的患儿100例,年龄2~8岁,采用随机数字表法分成PLMA置入组(PI组)和气管内插管组(TI组),每组50例。两组患儿均未给予术前镇静药物。使用8%七氟烷进行诱导,随后以预定的浓度维持10 min。PI组患儿置入PLMA,TI组患儿进行气管内插管。每隔1分钟监测两组患儿七氟烷呼气末浓度、MAC值和BIS值,直至喉罩成功置入或成功气管插管。记录两组患儿喉罩置入或气管插管的并发症。结果与TI组同时点比较,PI组患儿麻醉诱导后1~10 min时七氟烷MAC值均明显降低(P<0.05),麻醉诱导后2~10 min时七氟烷呼气末浓度均明显降低(P<0.05),麻醉诱导后8~10 min时BIS值均明显升高(P<0.05)。两组喉罩置入或插管并发症发生率比较差异均未见统计学意义(P>0.05)。结论 BIS监测下小儿PLMA置入所需的七氟烷浓度较气管内插管所需的浓度更低。
Objective To compare the end-tidal sevoflurane concentrations and the lowest alveolar effective concentration (MAC) values required for pediatric esophageal drainage laryngeal mask (PLMA) insertion and endotracheal intubation monitoring with bispectral index (BIS). Methods A total of 100 children with short-term abdominal surgery were enrolled in this study. They were 2 to 8 years old. They were divided into PLMA group (PI group) and endotracheal intubation group (TI group) by random number table. Two groups of children were not given preoperative sedative drugs. Induced with 8% sevoflurane, followed by a predetermined concentration for 10 min. Children in PI group were placed in PLMA, and children in TI group were given endotracheal intubation. Two groups of children were monitored for sevoflurane end-tidal concentrations, MAC values and BIS values every one minute until the laryngeal mask was successfully inserted or successfully intubated. Record two groups of children laryngeal mask placement or tracheal intubation complications. Results Compared with TI group, the MAC value of sevoflurane in PI group was significantly decreased 1 ~ 10 min after anesthesia induction (P <0.05), and the end-tidal concentration of sevoflurane in PI group was significantly lower at 2-10 min after anesthesia induction (P <0.05). The BIS values were significantly increased at 8-10 min after induction of anesthesia (P <0.05). There were no significant differences in the incidence of complications between two groups of laryngeal masks (P> 0.05). Conclusion The concentration of sevoflurane required for PLMA insertion in children under BIS monitoring is lower than that required for endotracheal intubation.