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
计量
- 文章访问数: 306
- HTML全文浏览量: 104
- PDF下载量: 21
- 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

HTML全文

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

下载: 导出CSV

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。

下载: 导出CSV

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

下载: 导出CSV

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。

下载: 导出CSV

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。

下载: 导出CSV

参考文献(20)

[1]	MENDES I C, SOUSA H, MANRIQUE M, et al. Cochlear implantation in incomplete partition type Ⅲ[J]. Acta Otorrinolaringol Esp (Engl Ed), 2023, 74(1): 63-65. doi: 10.1016/j.otorri.2022.03.001
[2]	VELDE H M, RADEMAKER M M, DAMEN J, et al. Prediction models for clinical outcome after cochlear implantation: a systematic review[J]. J Clin Epidemiol, 2021, 137: 182-194. doi: 10.1016/j.jclinepi.2021.04.005
[3]	汤英华, 周懿之, 陆志强, 等. BIS指导静吸复合麻醉对老年髋关节置换术早拔管的临床价值[J]. 中国老年学杂志, 2019, 39(3): 574-576. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ201903025.htm TANG Y H, ZHOU Y Z, LU Z Q, et al. Clinical value of BIS guidance combined anesthesia for early extubation in elderly patients with hip replacement[J]. Chinese Journal of Gerontology, 2019, 39(03): 574-576. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ201903025.htm
[4]	梁玉丹, 李静洁, 刘博研, 等. 丙泊酚和七氟烷对电子耳蜗植入术婴幼儿肠道菌群多样性的影响[J]. 医学研究生学报, 2020, 33(3): 285-288. https://www.cnki.com.cn/Article/CJFDTOTAL-JLYB202003014.htm LIANG Y D, LI J J, LIU B Y, et al. Effects of propofol and sevoflurane on intestinal flora diversity in infants undergoing cochlear implantation[J]. Journal of Medical Postgraduates, 2020, 33(3): 285-288. https://www.cnki.com.cn/Article/CJFDTOTAL-JLYB202003014.htm
[5]	薛期能, 夏俊明, 陆瑾, 等. 电子耳蜗植入术患儿父母焦虑程度及其影响因素分析[J]. 复旦学报(医学版), 2023, 50(4): 556-560. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYK202304011.htm XUE Q N, XIA J M, LU J, et al. Levels of anxiety in parents of children undergoing cochlear implantation and its influence factors[J]. Fudan University Journal of Medical Sciences, 2023, 50(4): 556-560. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYK202304011.htm
[6]	刘炎, 吴哲, 任万陆. 不同麻醉方式对老年股骨颈骨折行人工股骨头置换术的效果及预后的影响[J]. 中国老年学杂志, 2021, 41(17): 3682-3685. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ202117016.htm LIU Y, WU Z, REN W L. Effect of different anesthetic mode on aged femoral neck fracture patients performed with artificial femoral head replacement and its prognosis[J]. Chinese Journal of Gerontology, 2021, 41(17): 3682-3685. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ202117016.htm
[7]	卢易, 陈丽芬, 刘华程, 等. 吸入和全凭静脉麻醉用于患儿纤维支气管镜检查效果的比较[J]. 临床麻醉学杂志, 2020, 36(12): 1161-1164. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ202012005.htm LU Y, CHEN L F, LIU H C, et al. Comparison of the effects of inhalation and total intravenous anesthesia in children undergoing fiberoptic bronchoscopy[J]. Journal of Clinical Anesthesiology, 2020, 36(12): 1161-1164. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ202012005.htm
[8]	姚博炜, 高斌, 穆婧. 右美托咪定在胃癌根治术全凭静脉麻醉用药中的应用效果及安全性分析[J]. 中国现代应用药学, 2023, 40(5): 664-667. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYD202305012.htm YAO B W, GAO B, MU J. Analysis of the effect and safety of dexmedetomidine in total intravenous anesthesia for radical gastrectomy[J]. Chinese Journal of Modern Applied Pharmacy, 2023, 40(5): 664-667. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYD202305012.htm
[9]	曾如筱, 田冶, 刘晓梅. 肺保护性通气配合静吸复合麻醉在小儿电子耳蜗植入术中的应用效果及安全性[J]. 武警医学, 2022, 33(9): 742-744, 747. https://www.cnki.com.cn/Article/CJFDTOTAL-WJYX202209002.htm ZENG R X, TIAN Y, LIU X M. Effect and safety of pulmonary protective ventilation combined with intravenous inhalational anesthesia in children treated with electronic cochlear implantation[J]. Medical Journal of the Chinese People' s Armed Police Force, 2022, 33(9): 742-744, 747. https://www.cnki.com.cn/Article/CJFDTOTAL-WJYX202209002.htm
[10]	牛晓光, 仝烨峰. 瑞芬太尼、丙泊酚复合全凭静脉麻醉对老年肋骨骨折切开复位内固定手术患者术后认知功能的影响[J]. 中国老年学杂志, 2022, 42(10): 2394-2397. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ202210024.htm NIU X G, TONG Y F. Effect of remifentanil and propofol combined with intravenous anesthesia on postoperative cognitive function in elderly children undergoing open reduction and internal fixation of rib fracture[J]. Chinese Journal of Gerontology, 2022, 42(10): 2394-2397. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ202210024.htm
[11]	韩宏亮, 洪道先, 陈英, 等. 异氟烷调控NF-κB/iNOS-COX2信号通路抑制三叉神经节卫星胶质细胞炎症的研究[J]. 中华全科医学, 2021, 19(11): 1831-1835. doi: 10.16766/j.cnki.issn.1674-4152.002178 HAN H L, HONG D X, CHEN Y, et al. Inhibition of trigeminal ganglion satellite glial cell inflammation by isohalothane regulating the NF-κB/iNOS-COX2 signalling pathway[J]. Chinese Journal of General Practice, 2021, 19(11): 1831-1835. doi: 10.16766/j.cnki.issn.1674-4152.002178
[12]	万建见, 刘万红. 人工电子耳蜗植入术后电极阻抗和T/C值变化的临床研究[J]. 世界最新医学信息文摘, 2018, 18(27): 67-68. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201827042.htm WAN J J, LIU W H. A clinical study on changes of electrode impedance and T/C value after cochlear implantation[J]. World Latest Medicine Information, 2018, 18(27): 67-68. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201827042.htm
[13]	李雨恒, 李明月, 刘长卿. 升压药物预注射对全凭静脉麻醉下腹部手术患者升压反应性和术后恢复的影响[J]. 中国现代应用药学, 2022, 39(5): 663-668. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYD202205015.htm LI Y H, LI M Y, LIU C Q. Effects of vasopressors pre-infusion on vasopressor response and postoperative recovery in patients undergoing lower abdominal surgery under total intravenous anesthesia[J]. Chinese Journal of Modern Applied Pharmacy, 2022, 39(5): 663-668. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYD202205015.htm
[14]	刘军, 黄婉, 王卓丹, 等. 全凭静脉麻醉下镇痛-伤害性刺激指数对于腹腔镜手术疼痛刺激评估的有效性[J]. 实用医学杂志, 2019, 35(3): 403-406, 411. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ201903016.htm LIU J, HUANG W, WANG Z D, et al. Effectiveness of analgesia nociception index on pain assessment in laparoscopic surgery under total intravenous anesthesia[J]. The Journal of Practical Medicine, 2019, 35(3): 403-406, 411. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ201903016.htm
[15]	徐静, 迟放鲁. 面神经监测在小儿电子耳蜗植入术中的应用[J]. 中国眼耳鼻喉科杂志, 2020, 20(1): 13-15. https://www.cnki.com.cn/Article/CJFDTOTAL-YRBH202001007.htm XU J, CHI F L. Application of facial nerve monitoring in pediatric cochlear implantation[J]. Chinese Journal of Ophthalmology and Otorhinolaryngology, 2020, 20(1): 13-15. https://www.cnki.com.cn/Article/CJFDTOTAL-YRBH202001007.htm
[16]	孟雪, 张哲, 殷悦, 等. 不同药物及给药途径对全麻手术老年患者呼吸功能的影响[J]. 中国老年学杂志, 2019, 39(18): 4498-4501. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ201918045.htm MENG X, ZHANG Z, YIN Y, et al. Effects of different drugs and routes of administration on respiratory function in elderly children undergoing general anesthesia[J]. Chinese Journal of Gerontology, 2019, 39(18): 4498-4501. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ201918045.htm
[17]	郗昕, 韩东一, 黄德亮, 等. Nucleus 24M型人工耳蜗植入后电极阻抗的变化[J]. 临床耳鼻咽喉科杂志, 2003, 17(10): 593-595. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH200310009.htm XI X, HAN D Y, HUANG D L, et al. A longitudinal study of electrode impedance in Nucleus 24M cochlear implant users[J]. Journal of Clinical Otolaryngology, 2003, 17(10): 593-595. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH200310009.htm
[18]	刘玉梅. 舒适护理在电子耳蜗植入术患儿中的应用分析[J]. 当代护士(下旬刊), 2018, 25(7): 93-94. https://www.cnki.com.cn/Article/CJFDTOTAL-DDHZ201807044.htm LIU Y M. Application analysis of comfort nursing in children undergoing electronic cochlear implantation[J]. Modern Nurse, 2018, 25(7): 93-94. https://www.cnki.com.cn/Article/CJFDTOTAL-DDHZ201807044.htm
[19]	王浩然, 王迪, 曹汉忠, 等. 不同七氟醚挥发罐起始浓度设定在中流量静吸复合麻醉中的应用[J]. 中国临床医学, 2023, 30(2): 330-334. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX202302020.htm WANG H R, WANG D, CAO H Z, et al. Application of different sevoflurane vaporizer initial concentration settings in middle-flow combined intravenousinhalation anesthesia[J]. Chinese Journal of Clinical Medicine, 2023, 30(2): 330-334. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX202302020.htm
[20]	马东晖, 王胜春, 钟桥生. 不同右美托咪定给药时机在小儿电子耳蜗植入术中的应用效果观察[J]. 中国现代药物应用, 2020, 14(8): 189-191. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY202008092.htm MA D H, WANG S C, ZHONG Q S. Application of dexmedetomidine at different administration times in children undergoing electronic cochlear implantation[J]. Chinese Journal of Modern Drug Application, 2020, 14(8): 189-191. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY202008092.htm