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| 脑状态指数预测龋齿手术患儿全麻苏醒期躁动的可行性 |
| Feasibility of cerebral state index predicting emergence agitation in children undergoing dental caries surgery |
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| DOI：10.12089/jca.2021.04.005 |
| 中文关键词: 脑状态指数 儿童 龋齿手术 苏醒期躁动 |
| 英文关键词: Cerebral state index Child Dental caries surgery Emergence agitation |
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| 中文摘要: |
目的 分析围术期脑状态指数（CSI）与患儿全麻苏醒期躁动（EA）的相关性，并探讨CSI预测EA的可行性。
方法 选取择期行口腔龋齿治疗手术的患儿100例，男58例，女42例，年龄2～7岁，ASA Ⅰ或Ⅱ级，根据全麻苏醒期患儿有无躁动分为两组：躁动组（A组）和无躁动组（NA组）。所有患儿静脉麻醉诱导气管插管后使用多功能组合式监护仪（HXD-I）监测CSI，分别记录插管后（T1）、手术开始20 min（T2）、停麻醉药时（T3）、拔管后（T4）及唤醒时（T5）的CSI，包括镇静指数（WLi）、镇痛指数（PTi）、皮层下兴奋指数（SCEi）、皮层兴奋指数（CEi）、谵妄指数（DELi）、遗忘指数（AMi）、焦虑指数（ANXi）和舒适指数（CFi）。绘制相关指数的ROC曲线，计算各指数ROC曲线下面积（AUC）。
结果 患儿发生EA 21例(21%)。T1—T5时两组WLi、PTi、DELi和AMi差异均无统计学意义。T5时A组SCEi、CEi、ANXi和CFi明显大于NA组（P<0.05）。SCEi、CEi、ANXi和CFi预测EA的AUC分别为0.765、0.768、0.712和0.717，敏感性分别为81%、100%、85.7%和61.9%，特异性分别为70.9%、44.3%、49.4%和77.2%。
结论 SCEi、CEi、ANXi和CFi均可有效预测龋齿手术患儿全麻EA的发生，但SCEi的预测效能最高。 |
| 英文摘要: |
Objective To analyze the correlation between the cerebral state indexes (CSI) and emergence agitation (EA) during general anesthesia recovery in children, and to explore the feasibility of CSI in predicting EA.
Methods A total of 100 children, 58 males, 42 females, aged 2-7 years, ASA physical statusⅠ or Ⅱ who received elective dental caries treatment were selected. According to the occurrence of emergence agitation during the general anesthesia recovery, children were divided into the agitation group (group A) and no-agitation group (group NA). Multifunctional combined instrument (HXD-I) was used to monitor the CSI of children. The wavelet index (WLi), pain threshold index (PTi), subcortical excitation index (SCEi), cortical excitation index (CEi), delirium index (DELi), amnesia index (AMi), anxiety index (ANXi) and comfort index (CFi) were recorded after intubation (T1), 20 minutes after the beginning of the operation (T2), at the time of anesthetics withdrawal (T3), after extubation (T4) and awakening time point (T5). Receiver-operating characteristic (ROC) curves were computed to evaluate the predictive performance of the cerebral state indexes in emergence agitation during general anesthesia recovery.
Results Emergence agitation occurred in 21 children in group A, while 79 children in group NA had no occurrence of emergence agitation during the awakening period. There were no significant differences in WLi, PTi, DELi, and AMi at T1-T5 between the two groups. At the time point of T5, there were statistically significant differences between the two groups in the SCEi, CEi, ANXi, and CFi. The area under the ROC curve (AUC) of SCEi, CEi, ANXi, and CFi were 0.765, 0.768, 0.712, and 0.717; the sensitivity were 81%, 100%, 85.7%, and 61.9%; the specificity were 70.9%, 44.3%, 49.4%, and 77.2%, respectively.
Conclusion SCEi, CEi, ANXi, and CFi are cerebral state indexes related to general anesthesia recovery, which can predict the occurrence of emergence agitation in children undergoing dental caries surgery. The test effectiveness of SCEi was the best among the four indexes. |
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