靶控输注丙泊酚与瑞芬太尼复合Narcotrend监测在唤醒开颅中的应用

Target-controlled infusion of propofol and remifentanil combined with Narcotrend monitoring for craniotomy with intraoperative awakening

目的探讨Narcotrend监测在唤醒开颅麻醉中的应用价值。方法30例需行脑功能区手术病人随机等分为监测组与非监测组,监测组病人监测Narcotrend分级(NT)及指数(NI),非监测组不进行Narcotrend监测。麻醉方法均选用丙泊酚联合瑞芬太尼靶控输注,监测组至NI≤46、非监测组当病人意识消失后,置入喉罩;术中监测组维持NI≤46,非监测组根据血流动力学调整丙泊酚浓度维持麻醉。处理硬脑膜时,丙泊酚和瑞芬太尼开始减量,病人呼唤睁眼后,拔出喉罩。记录置入喉罩时和唤醒时丙泊酚效应室浓度(Ce),置入喉罩前1min、即刻的平均动脉压、心率,监测组NI及减浅麻醉至呼唤睁眼时间,比较两组间各参数的差异。结果监测组诱导所需丙泊酚浓度小于非监测组,P<0.05。监测组唤醒时间(10.3±3.0)min明显短于非监测组(14.6±3.0)min,P<0.01。置入喉罩前后两组血流动力学波动不明显,NI与丙泊酚浓度呈明显的负相关。结论唤醒开颅时,在Narcotrend指导下,可以显著降低丙泊酚所需靶浓度,增加唤醒的可控性。

Objective To explore the application of Narcotrend monitoring to anesthesia for craniotomy with intraoperative awakening. Methods Thirty patients undergoing craniotomy with intraoperative awakening were equally divided into monitoring group and non-monitoring group. The Narcotrend stage （NT） and index （NI） were monitored in monitoring group but not in non-monitoring group. The patients were anesthetized with remifentanil and propofol infused by target-controlled infusion. The laryngeal mask was inserted when NI ≤ 46 in monitoring group, and defined as unawareness in non-monitoring group. NI was kept at ≤ 46 in monitoring group, and the concentration of propofol was regulated according to hemodynamics to maintain the narcosis. The concentrations of propofol and remifentanil were reduced when treating the dura. After the patient was awakened, the laryngeal mask was extracted. The effect-site concentration of propofol at the time of laryngeal mask airway insertion and the patients＇ awakening, the heart rate and mean arterial pressure immediately and 1 min before the insertion of laryngeal mask, the NI in monitoring group and the time from reducing anesthesia depth to patient awakening were recorded and the differences in these parameters between the two groups. Results The effect-site concentration of propofol in monitoring group were lower than that in non-monitoring group, P〈0.05. The awakening time was significantly lower in monitoring group （10.3±3.0 min） than non-monitoring group （14.6±3.0 min）, P〈0.01. Before and after the insertion of laryngeal mask, the hemodynamic changes were not apparent, and the NI was significantly negatively correlated with the effect-site concentration of propofol. Conclusion Narcotrend monitoring could decrease the effect-site concentration of propofol and increase the controllability of intraoperative awakening during craniotomy.