不同麻醉药对瞳孔大小的影响

本文由“小麻哥的日常”授权转载

摘要译文（供参考）

全麻时挥发性麻醉药和静脉麻醉药对儿童瞳孔功能影响的前瞻性观察研究

背景：

对光反射反映中枢神经系统功能紊乱，也会受到麻醉剂的影响。

目的：

我们评估这些影响在儿科患者中是否随麻醉药的不同而有所不同。

方法：

将20例3~12岁拟行全麻择期手术的患儿随机分为异丙酚组和七氟要组，分别在麻醉期间的5个时间点进行瞳孔测量：

T1，确认意识丧失后；

T2，气管插管后；

T3，切皮时；

T4，切皮后1小时；

和T5，气管拔管前。

主要结果是T4时的神经瞳孔指数，次要结果是其他瞳孔测量参数，包括瞳孔直径、瞳孔直径变化百分比、扩张速度和收缩速度。

结果：

T4时，七氟烷组的神经瞳孔指数显著较低(中位数差异，0.30；95%CI，0.00-0.70；p=.036)。

此外，七氟烷组在所有时间点的神经瞳孔指数均较低。

时间和组相互作用对收缩速度和扩张速度的影响有显著差异[F(1，4)=16.68，p=.002；F(1，4)=14.78，p=.008]，但在神经瞳孔指数、瞳孔直径和瞳孔直径变化百分比方面无差异。

在基线特征、各时间点的瑞芬太尼流速和瑞芬太尼总输注量方面未观察到组间差异。

结论：

全麻下患儿的神经瞳孔指数值受所用麻醉药的影响，在全麻下评价神经学瞳孔指数时应考虑这一因素。

关键词：全身麻醉；小儿；瞳孔光反射。

原文摘要

Comparison of effects of volatile and intravenous anesthetics on pupillary function during general anesthesia in children: 

A prospective observational study

Background: The light reflex, which reflects central nervous system dysfunction, can also be affected by anesthetic agents.

Aims: We evaluated whether these effects differed according to the anesthetic agent in pediatric patients.

Methods: Twenty children aged 3-12 years who were scheduled to undergo elective surgery under general anesthesia were randomly allocated to propofol and sevoflurane groups and underwent pupillometric assessments at five points during anesthesia: T1, after confirming loss of consciousness; T2, after endotracheal intubation; T3, at the time of skin incision; T4, 1 h after skin incision; and T5, before endotracheal extubation. The primary outcome was the Neurological Pupil index at T4, and the secondary outcomes were other pupillometric parameters, including pupil diameter, percentage of change in pupil diameter, dilation velocity, and constriction velocity.

Results: At T4, the Neurological Pupil index was significantly lower in the sevoflurane group (median difference, 0.30; 95% CI, 0.00 to 0.70; p = .036). Furthermore, the Neurological Pupil index at all time points was lower in the sevoflurane group. The time-and-group interaction effects on constriction velocity and dilation velocity were significantly different [F(1, 4) = 16.68, p = .002; F(1, 4) = 14.78, p = .008, respectively] but were not different on the Neurological Pupil index, pupil diameter, and percentage of change in pupil diameter. No intergroup differences were observed in the baseline characteristics, the flow rate of remifentanil at each time point, and total infused remifentanil.

Conclusion: The Neurological Pupil index value in pediatric patients under general anesthesia is affected by the anesthetic agent used; this factor requires consideration in evaluations of the Neurological Pupil index during general anesthesia.

Keywords: general anesthesia; pediatric; pupillary lig

ht reflex.

免责声明：

文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：Michel.米萱

校对：MiLu.米鹭

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