不同麻醉方法用于小儿电子耳蜗植入术中的临床比较

方响响; 鞠学军; 姜巧妹; 孟玮; 何双八

doi:10.16766/j.cnki.issn.1674-4152.003362

不同麻醉方法用于小儿电子耳蜗植入术中的临床比较

doi: 10.16766/j.cnki.issn.1674-4152.003362

1.
东南大学医学院附属南京同仁医院麻醉科，江苏南京 211100
2.
东南大学医学院附属南京同仁医院耳鼻咽喉科

基金项目:

国家自然科学基金项目 82171153

江苏省自然科学基金项目 BK20211012

详细信息

通讯作者:
何双八，E-mail：Hesb@njtrh.org

中图分类号: R614 R764.9
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- 文章访问数: 42
- HTML全文浏览量: 14
- PDF下载量: 8
- 被引次数: 0
出版历程
- 收稿日期: 2023-11-12
- 网络出版日期: 2024-03-27

Clinical comparison of different anesthesia methods for electronic cochlear implantation in children

1.
Department of Anaesthesia, Nanjing Tongren Hospital, Southeast University School of Medicine, Nanjing, Jiangsu 211100, China

摘要

摘要: 目的本研究旨在比较分析静吸复合麻醉与全凭静脉麻醉在小儿电子耳蜗植入术中的应用效果和安全性。方法回顾性分析2018年5月—2023年3月择期于南京同仁医院行小儿电子耳蜗植入术的患儿100例，按麻醉方式不同分成静吸复合麻醉(对照组, 50例)和全凭静脉麻醉(研究组, 50例)。比较2组一般情况、手术前后血流动力学及脑电双频指数(BIS)、术后即时电阻抗、术后躁动率及苏醒时间、术后氧化应激水平以及不良反应发生情况。结果 2组年龄，身高，体重，麻醉时间，血流动力学指标(SBP、DBP、HR)，BIS比较差异均无统计学意义(P>0.05)。研究组术毕即时电阻抗均低于对照组[低频：(2.57±0.40)kΩ vs. (3.93±0.83)kΩ；高频：(7.00±0.31)kΩ vs. (8.37±0.42)kΩ，P<0.001]。研究组术后躁动评分和苏醒时间均低于对照组(P<0.001)。2组患者术后氧化应激水平比较差异有统计学意义(P<0.001)。2组不良反应发生率比较差异无统计学意义(P＞0.05)。结论在小儿电子耳蜗植入术中，全凭静脉麻醉相较于静吸复合麻醉更安全有效。全凭静脉麻醉在术中血流动力学控制、苏醒时间、氧化应激水平以及术后即时电阻抗表现出优势。因此，在临床实践中，应优先考虑全凭静脉麻醉作为小儿电子耳蜗植入术的麻醉方式。然而，麻醉方式的选择仍需根据患者个体情况和麻醉团队的经验进行综合评估。
- 静吸复合麻醉 /
- 全凭静脉麻醉 /
- 小儿电子耳蜗植入术 /
- 术后即时电阻抗
Abstract: Objective The aim of this study was to compare the application effectiveness and safety of combined inhalation anesthesia and total intravenous anesthesia in pediatric cochlear implantation surgery. Methods A retrospective analysis was conducted on 100 pediatric patients who underwent cochlear implantation surgery at Nanjing Tongren Hospital from May 2018 to March 2023. They were divided into two groups based on the different anesthesia methods: combined inhalation anesthesia (control group) and total intravenous anesthesia (study group). The differences between the two groups were compared in terms of general conditions, pre-and post-operative hemodynamics and bispectral index (BIS), postoperative immediate electrical impedance, postoperative restlessness and recovery time, postoperative oxidative stress levels, and adverse reactions. Results There were no significant difference in age, height, weight, anesthesia time, hemodynamic indexes (SBP, DBP, HR) and BIS index between the study group and the control group (P>0.05). The immediate electrical impedance at the end of surgery in the study group was lower than that in the control group [low-frequency: (2.57±0.40) kΩ vs. (3.93±0.83) kΩ; high-frequency: (7.00±0.31) kΩ vs. (8.37±0.42) kΩ, P<0.001]. The postoperative sedation-agitation scale(RASS) and recovery time of the study group were lower than those of the control group (P<0.001). There was significant difference in postoperative oxidative stress levels between the two groups (P<0.001). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Total intravenous anesthesia is a safer and more effective approach compared to combined anesthesia for cochlear implantation surgery in children. Total intravenous anesthesia offers notable benefits in terms of intraoperative hemodynamics control, recovery time, oxidative stress levels, and postoperative impedance. Therefore, total intravenous anesthesia should be considered as the primary option in clinical practice for cochlear implantation surgery in children. However, the selection of the anesthetic modality should be carefully evaluated, considering the unique needs for each patient and the experience of the anesthesia team.
- Combined intravenous anesthesia /
- Total intravenous anesthesia /
- Cochlear implantation in children /
- Immediate postoperative electrical impedance

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表 1 2组行电子耳蜗植入术患儿术前一般情况比较(x±s)

Table 1. Comparison of general conditions before cochlear implantation between the two groups (x±s)

组别	例数	体重(kg)	身高(cm)	年龄(岁)	麻醉时间(min)
研究组	50	23.59±11.98	119.5±22.40	5.48±2.83	98.52±7.14
对照组	50	23.58±12.06	119.5±22.60	5.14±2.88	98.32±7.83
t值		0.001	0.011	0.594	0.133
P值		0.999	0.991	0.554	0.894

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表 2 2组行电子耳蜗植入术患儿围手术期血流动力学及BIS比较(x±s)

Table 2. Comparison of perioperative hemodynamics and BIS values between the two groups of children undergoing cochlear implantation (x±s)

组别	例数	SBP(mmHg)		DBP(mmHg)		HR(次/min)		BIS
组别	例数	术前	术后	术前	术后	术前	术后	术前	术后
研究组	50	96.42±4.87	98.36±3.70	65.00±3.45	66.02±3.66	98.70±6.07	98.58±5.93	96.94±2.24	95.40±2.20
对照组	50	96.70±4.36	99.50±4.16	65.50±3.61	65.66±3.54	98.72±6.63	98.20±7.56	97.18±2.07	95.26±2.30
t值		0.303	1.448	0.708	0.499	0.016	0.280	0.556	0.311
P值		0.763	0.151	0.480	0.619	0.987	0.780	0.579	0.757
注：1 mmHg=0.133 kPa。

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表 3 2组行电子耳蜗植入术患儿术毕即时电阻抗比较(x±s，kΩ)

Table 3. Comparison of immediate electrical impedance after cochlear implantation between the two groups (x±s, kΩ)

组别	例数	Zh	Zl
研究组	50	7.00±0.31	2.57±0.40
对照组	50	8.37±0.42	3.93±0.83
t值		18.549	10.437
P值		<0.001	<0.001

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表 4 2组行电子耳蜗植入术患儿术后躁动评分及苏醒时间比较

Table 4. Comparison of postoperative agitation scores and recovery time between the two groups of children undergoing cochlear implantation

组别	例数	RASS[M(P₂₅, P₇₅)，分]	苏醒时间(x±s，min)
研究组	50	0(0, 2)	14.86±5.64
对照组	50	1(0, 2)	24.94±6.15
统计量		-3.554^a	8.543^b
P值		<0.001	<0.001
注：^a为Z值，^b为t值。

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表 5 2组行电子耳蜗植入术患儿氧化应激水平比较(x±s)

Table 5. Comparison of oxidative stress levels between the two groups of children undergoing cochlear implantation (x±s)

组别	例数	MDA(nmol/L)		SOD(U/L)
组别	例数	术前	术后	术前	术后
研究组	50	6.15±1.46	2.09±0.70^a	120.50±16.57	212.58±40.42^a
对照组	50	6.54±1.43	4.02±1.11^a	118.74±21.48	291.34±25.00^a
t值		1.351	10.418	0.459	11.650
P值		0.180	<0.001	0.648	<0.001
注：与同组术前比较，^aP<0.001。

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