Correlation between cerebral state index and end-tidal concentration of sevoflurane in children with cerebral palsy undergoing adjustment surgery
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摘要:目的 探讨脑状态指数(CSI)与呼气末七氟醚浓度(CETSev)在脑瘫患儿七氟醚全身麻醉期间的相关性。方法 选择80例择期下肢调整手术的脑瘫患儿，采用七氟醚全身麻醉和常规监测，持续监测CETSev和CSI。于诱导前(T0)、喉罩置入后(T1)和CETSev 0.8%(T2)、CETSev 1.2%(T3)、CETSev 1.6%(T4)、CETSev 2.0%(T5)、CETSev 2.4%(T6)、CETSev 2.8%(T7)时，以及停吸七氟醚(T8)和下降期CETSev 1.4%(T9)、CETSev 1.2%(T10)、CETSev 1.0%(T11)、CETSev 0.8%(T12)、CETSev 0.6%(T13)、CETSev 0.4%(T14)和喉罩拔除前(T15)、喉罩拔除后(T16)时，记录CETSev和CSI值。分析CETSev和CSI的相关性。结果 在CETSev上升期(T0~T7)，T2~T7的CSI低于T0，差异有统计学意义(P < 0.05)；CSI与CETSev呈负相关(r=-0.890，P < 0.001)。在CETSev下降期(T8~T16)，T9~T16的CSI高于T8，差异有统计学意义(P < 0.05)；CSI与CETSev呈负相关(r=-0.889，P < 0.001)。结论 在脑瘫调整手术患儿CETSev的上升期和下降期，CSI与CETSev均呈显著负相关，故可通过CSI指导全身麻醉期间的七氟醚精准用药。Abstract:Objective To investigate the correlation between cerebral state index (CSI) and end-tidal concentration of sevoflurane (CETSev) in children with cerebral palsy during sevoflurane general anesthesia.Methods Eighty children with cerebral palsy for selective lower limb adjustment surgery were selected. Sevoflurane general anesthesia and routine monitoring were performed, and CETSev as well as CSI were continuously monitored. Before induction (T0), after laryngeal mask implantation (T1), CETSev 0.8% (T2), CETSev 1.2% (T3), CETSev 1.6% (T4), CETSev 2.0%(T5), CETSev 2.4% (T6), CETSev 2.8% (T7), stop taking sevoflurane (T8) and declining stages including CETSev 1.4% (T9), CETSev 1.2%(T10), CETSev 1.0% (T11), CETSev 0.8% (T12), CETSev 0.6% (T13), CETSev 0.4% (T14), before (T15) and after (T16) laryngeal mask removal, the values of CETSev and CSI were recorded. The correlation between CETSev and CSI introduction was analyzed.Results During the rising period of CETSev (T0 to T7), the CSI of T2 to T7 was significantly lower than that of T0 (P < 0.05); CSI was negatively correlated with CETSev (r=-0.890, P < 0.001). During the decreasing period of CETSev (T8 to T16), CSI values of T9 to T16 were significantly higher than that of T8 (P < 0.05); CSI was negatively correlated with CETSev (r=-0.889, P < 0.001).Conclusion There is a significant negative correlation between CSI and CETSev in the rising and descending period of CETSev in children with cerebral palsy undergoing palsy adjustment surgery. Therefore, CSI can be used to guide the accurate use of sevoflurane during general anesthesia.
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Keywords:
- sevoflurane /
- cerebral state index /
- cerebral palsy /
- children /
- concentration
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表 1 80例患儿CETSev上升期不同时点的监测变量(x±s)
指标 T0 T1 T2 T3 T4 T5 T6 T7 CETSev/% 0 0 0.8 1.2 1.6 2.0 2.4 2.8 CSI 90.5±2.8 70.2±5.1** 65.7±6.4** 58.0±6.7** 50.8±6.6** 45.7±5.2** 42.7±3.5** 40.5±1.7** MAC-Sev 0 0 0.3±0** 0.5±0.1** 0.7±0.1** 0.9±0.1** 1.0±0.1** 1.2±0.8** HR/(次/min) 109.0±13.0 107.0±12.0* 105.0±12.0** 101.0±12.0** 101.0±14.0** 103.0±13.0** 104.0±14.0** 100.0±14.0** SBP/mmHg 114.0±11.0 109.0±10.0** 106.0±9.0** 102.0±11.0** 101.0±12.0** 104.0±13.0** 103.0±11.0** 101.0±11.0* * DBP/mmHg 67.0±10.0 63.0±9.0** 61.0±8.0** 58.0±9.0** 57.0±9.0** 59.0±10.0** 59.0±9.0** 56.0±10.0** CETSev: 呼气末七氟醚浓度; CSI: 脑状态指数; MAC-Sev: 七氟醚最低肺泡有效浓度; HR: 心率; SBP: 收缩压; DBP: 舒张压。与T0比较, * P < 0.05, * * P < 0.01。 
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表 2 80例患儿CETSev下降期不同时点的监测(x±s)
指标 T8 T9 T10 T11 T12 T13 T14 T15 T16 CETSev/% 2.0±0.1 1.4 1.2 1.0 0.8 0.6 0.4 0.2±0.1 0 CSI 42.1±2.4 43.5±4.4** 44.5±5.8** 47.4±7.8** 52.2±9.0** 60.4±8.9** 70.3±8.3** 87.8±2.6** 90.1±2.1** MAC-Sev 0.9±0.1 0.6±0.1 0.5±0.1 0.4±0.1 0.3±0.1 0.2±0 0.1±0 0.1±0 0 HR/(次/min) 97.0±11.0 97.0±11.0 97.0±12.0 97.0±12.0 98.0±13.0 99.0±13.0 104.0±11.0* 112.0±10.0* 110.0±12.0* SBP/mmHg 102.0±9.0 103.0±8.0 103.0±8.0 104.0±9.0** 105.0±9.0** 107.0±9.0** 110.0±8.0** 115.0±8.0** 113.0±8.0** DBP/mmHg 57.0±9.0 58.0±9.0 58.0±8.0 58.0±8.0 59.0±8.0* 62.0±9.0** 64.0±9.0** 68.0±8.0** 66.0±8.0** CETSev: 呼气末七氟醚浓度; CSI: 脑状态指数; MAC-Sev: 七氟醚最低肺泡有效浓度; HR: 心率; SBP: 收缩压; DBP: 舒张压。与T8比较, * P < 0.05, * * P < 0.01。
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[1] WONGPRASARTSUK P, STEVENS J. Cerebral palsy and anaesthesia[J]. Pediatr Anesth, 2002, 12(4): 296-303. doi: 10.1046/j.1460-9592.2002.00635.x
[2] MELLO S S, SARAIVA R A. Electroneourophysiological changes in anesthesia with sevoflurane: comparative study between healthy and cerebral palsy patients[J]. Rev Bras Anestesiol, 2003, 53(2): 150-159. doi: 10.1590/S0034-70942003000200002
[3] 赵泽宇, 程庆, 张蓉, 等. 脑状态指数与脑电双频指数在脑性瘫痪患儿七氟醚麻醉中镇静水平的相关性[J]. 中国医药导报, 2015, 12(34): 90-93. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201534025.htm [4] CHO S H, KIM S S, HYUN D M, et al. Comparison between cerebral state index and bispectral index during desflurane anesthesia[J]. Korean J Anesthesiol, 2018, 71(6): 447-452. doi: 10.4097/kja.d.17.00084
[5] 吴坤, 谷春红, 王师建. 压力控制通气和容量控制通气在小儿喉罩全麻腹腔镜手术中的应用[J]. 中国医疗器械信息, 2018, 24(10): 118-119. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGQX201810059.htm [6] 徐莉, 侯立功, 王江涛, 等. 不同潮气量机械通气治疗小儿急性肺损伤所致急性呼吸窘迫综合征的临床观察[J]. 中国临床医生杂志, 2019, 47(1): 98-101. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLYS201901034.htm [7] 张国华, 孙莉. 不同阿片类药物对意识消失时异丙酚用量及大脑皮质抑制速度和抑制程度的影响[J]. 医学研究杂志, 2015, 44(3): 63-67. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYZ201503020.htm [8] HAN D W, LINARES-PERDOMO O J, LEE J S, et al. Comparison between cerebral state index and bispectral index as measures of electroencephalographic effects of sevoflurane using combined sigmoidal E(max) model[J]. Acta Pharmacol Sin, 2011, 32(10): 1208-1214. doi: 10.1038/aps.2011.99
[9] NISHIYAMA T. Cerebral state index vs. bispectral index during sevoflurane-nitrous oxide anaesthesia[J]. Eur J Anaesthesiol, 2009, 26(8): 638-642. doi: 10.1097/EJA.0b013e328324e946
[10] ANDERSON R E, JAKOBSSON J G. Cerebral state monitor, a new small handheld EEG monitor for determining depth of anaesthesia: a clinical comparison with the bispectral index during day-surgery[J]. Eur J Anaesthesiol, 2006, 23(3): 208-212. doi: 10.1017/S0265021505002206
[11] SUDHAKARAN R, MAKKAR J, JAIN D, et al. Comparison of bispectral index and end-tidal anaesthetic concentration monitoring on recovery profile of desflurane in patients undergoing lumbar spine surgery[J]. Indian journal of anaesthesia, 2018, 62(7): 516. doi: 10.4103/ija.IJA_172_18
[12] KIP G, ONAL P, OZTAS N. Comparison of bispectral index values and depth of sedation during deep sedation using sevoflurane anesthesia in healthy children versus children with cerebral palsy[J]. Niger J Clin Pract, 2019, 22(6): 801. doi: 10.4103/njcp.njcp_553_18
[13] DA C, SRÂNGELO, DOMINGUES D L T. Regressão da anestesia geral em pacientes com paralisia cerebral: estudo comparativo utilizando o índice bispectral[J]. Revista Brasileira De Anestesiologia, 2006, 56(5): 431-442.
[14] WASS C T, WARNER M E, WORRELL G A, et al. Effect of general anesthesia in patients with cerebral palsy at the turn of the new millennium: a population-based study evaluating perioperative outcome and brief overview of anesthetic implications of this coexisting disease[J]. J Child Neurol, 2012, 27(7): 859-866.
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