麻醉趋势监测七氟醚麻醉下气管内插管麻醉深度的变化

Narcotrend for monitoring the anesthetic depth during endotracheal intubation in sevoflurane anesthesia

目的探讨麻醉趋势(NCT)用于七氟醚麻醉下气管内插管时麻醉深度变化监测的可行性。方法 ASAⅠ～Ⅱ级、年龄20～49岁择期行全麻下气管插管妇科手术患者30例,随机分为两组:单药组(单纯七氟醚诱导,n=15)和联合用药组(七氟醚联合罗库溴铵诱导,n=15)。单药组采用8%七氟醚吸入诱导,呼气末七氟醚浓度达到2MAC,维持3min后气管内插管,继续观察3min;联合组在睫毛反射消失时静脉注射罗库溴铵0.6mg/kg,其余用药与单药组相同。观察麻醉诱导过程中NCT、脑电双频谱指数(BIS)及血液动力学的变化。结果诱导前两组患者NCT、BIS、平均动脉压(MAP)、心率值无显著差异(P>0.05)。与插管前比较,单药组患者插管后NCT、BIS值显著上升(P<0.05),但均未超过60,联合组患者插管前后NCT、BIS值无明显改变(P>0.05)。插管后两组患者MAP、心律均升高,单药组较联合用药组上升幅度大(P<0.05)。结论单纯七氟醚麻醉诱导过程中,NCT能反映气管内插管伤害性刺激所致麻醉深度的变化。七氟醚联合罗库溴铵麻醉诱导过程中,NCT和BIS均不能反映气管内插管伤害性刺激所致麻醉深度的变化。

Objective To study the feasibility of using Narcotrend （NCT） in monitoring the anesthetic depth during endotracheal intubation in sevoflurane anesthesia. Methods Thirty ASA I-II patients （aged 20-49 years） undergoing gynecologic surgery under general anesthesia with tracheal intubation were randomized into sevoflurane group （n=15） and sevoflurane plus rocuronium group （n=15）. In the former group, anesthesia was induced with sevoflurane at the primary concentration of 8% till the final endexpiratory concentration reaching 2 MAC （minimum alveolar concentration） for 3 min, followed then by tracheal intubation and further observation of the indicators for another 3 min. The patients in sevoflurane plus rocuronium group received identical anesthesia procedures except for the administration of intravenous injection of rocuronium （0.6 mg/kg） after the loss of eyelash reflex. The NCT, BIS and hemodynamics were recorded during the process. Results No significant differences were noted in NCT, bispectral index （BIS）, MAP and heart rate before tracheal intubation between the two groups （P0.05）. The NCT and BIS increased significantly after tracheal intubation in sevoflurane group （P0.05）, but remained below 60. No significant changes in NCT and BIS occurred during intubation in sevoflurane plus rocuronium group （P0.05）. The mean arterial pressure （MAP） and heart rate were significantly increased in both groups after tracheal intubation in comparison with those before tracheal intubation （P0.05）, but the increment in sevoflurane group was significantly greater （P0.05）. Conclusion NCT may reflect the changes of the anesthetic depth resulting from the nociceptive stimulus of tracheal intubation in sevoflurane-induced anesthesia. NCT and BIS can not serve such a purpose in combined anesthesia with sevoflurane and rocuronium.