摘要
目的 评价脑电小波指数(WLI)监测患儿丙泊酚镇静深度的可行性.方法 本研究为前瞻性观察性试验.选择本院2016年7月至12月需行气管插管或喉罩全麻的择期手术患儿165例,年龄＞1～12岁,ASA分级Ⅰ或Ⅱ级,按年龄分为11组(n=15):＞1～2岁组、＞2～3岁组、＞3～4岁组、＞4～5岁组、＞5～6岁组、＞6～7岁组、＞7～8岁组、＞8～9岁组、＞9～10岁组、＞10～11岁组、＞11～12岁组.静脉注射丙泊酚3 mg/kg,注射时间＞30 s.于给药前即刻、给药结束后30、40、50、60、90、120、180、240 s时记录WLI值与BIS值.如年龄组之间存在差异,则合并差异无统计学意义的年龄组,重新分组.WLI值与BIS值的相关性采用Pearson线性相关分析,WLI值与BIS值的一致性分析采用Bland-Altman法.结果 实际入组患儿149例.＞1～5岁的4组之间、＞5～12岁的7组之间BIS值比较差异无统计学意义(P＞0.05).根据上述结果重新分组,＞1～5岁的4组患儿合并为＞1～5岁组(n=60),＞5～12岁的7组患儿合并为＞5～12岁组(n=89).与给药前即刻比较,2组给药结束后各时点WLI值和BIS值降低(P＜0.05).2组BIS值均于给药结束后60 s时最低,WLI值于给药结束后120和180 s最低(P＜0.05).＞1～5岁组给药结束后90和240 s时WLI值与BIS值比较差异无统计学意义(P＞0.05),其余时点比较差异有统计学意义(P＜0.05);＞5～12岁组给药结束后180和240 s时WLI值与BIS值比较差异无统计学意义(P＞0.05),其余时点比较差异有统计学意义(P＜0.05).＞1～5岁组和＞5～12岁组WLI值与BIS值Pearson相关系数分别为0.61和0.56(P＜0.001).Bland-Altman 一致性分析:＞1～5岁组和＞5～12岁组95％一致性区间界限分别为-48.4％～62.1％、-55.1％～101.5％,分别有4.6％(23/504)、5.1％(40/777)的点在95％一致性界限之外,2组95％一致性区间界限均超出临床可接受范围.结论 WLI可监测＞1～12岁患儿丙泊酚镇静深度,但相比BIS,其准确性较低.
Abstract
Objective To assess the feasibility of wavelet index(WLI)in monitoring the depth of sedation with propofol in pediatric patients.Methods This was a prospective observational trial.One hun-dred and sixty-five pediatric patients,aged＞1-12 yr,of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ,undergoing elective surgery requiring general anesthesia with endotracheal in-tubation or laryngeal mask airway from July to December 2016 in our hospital,were divided into 11 age groups(n=15 each):＞1-2 yr group,＞2-3 yr group,＞3-4 yr group,＞4-5 yr group,＞5-6 yr group,＞6-7 yr group,＞7-8 yr group,＞8-9 yr group,＞9-10 yr group,＞10-11 yr group,and＞11-12 yr group.General anesthesia was induced by injection of propofol 3 mg/kg for more than 30 s.WLI and BIS values were recorded immediately before administration and at 30,40,50,60,90,120,180 and 240 s af-ter the end of administration.If there were differences among age groups,age groups with no statistically sig-nificant differences were combined and re-grouped.Pearson linear correlation analysis and Bland-Altman consistency analysis were performed.Results A total of 149 pediatric patients were actually included.There were no significant differences in BIS values between 4 groups aged＞1-5 yr and between 7 groups aged＞5-12 yr(P＞0.05).Regrouping was performed based on the aforementioned results,4 groups of children aged＞1-5 yr were divided into＞1-5 yr group(n=60),and 7 groups of children aged＞5-12 yr were divided into＞5-12 yr group(n=89).WLI values and BIS values were significantly decreased at each time point after administration compared with immediately before administration in group aged＞1-5 yr and in group aged＞5-12 yr(P＜0.05).The BIS values were the lowest at 60 s after the end of the adminis-tration,and the WLI values were the lowest at 120 and 180 s after the end of the administration in two groups(P＜0.05).There were no statistically significant differences between WLI values and BIS values at 90 s and 240 s after the end of the administration(P＞0.05),and there was statistically significant differ-ence at the other time points in group aged＞1-5 yr(P＜0.05).There was no significant difference between WLI values and BIS values at 180 s and 240 s after the end of the administration(P＞0.05),but there were significant differences at the other time points in group aged＞5-12 yr(P＜0.05).The Pearson correlation coefficients between WLI values and BIS values were 0.61 and 0.56 in group aged＞1-5 yr and group aged＞5-12 yr,respectively(P＜0.001).Bland-Altman agreement analysis:In group aged＞1-5 yr and group aged＞5-12 yr,the 95％agreement limits were-0.484-0.621 and-0.551-1.015,respectively,and there were 4.6％(23/504)and 5.1％(40/777)of the points outside the 95％agreement limits,re-spectively,and both limits exceeded the clinically acceptable range.Conclusions WLI is feasible for mo-nitoring the depth of sedation with propofol in pediatric patients aged＞1-12 yr,but the accuracy is lower than BIS.
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