Narcotrend监测在颅脑肿瘤切除手术中的应用

The clinical study of Narcotrend monitoring in neuroanesthesia for brain tumor resection

目的探讨Narcotrend监测在开颅脑肿瘤切除手术中的应用价值。方法全麻下行开颅脑肿瘤切除术患者50例,ASAⅠ或Ⅱ级,随机均分为Narcotrend监测组(A组)和对照组(B组)。A组以Narcotrend监测结果判断麻醉深度并调整用药,使Narcotrend指数(NI)维持在D2～E1水平;B组由同一麻醉医师根据临床经验调节麻醉用药。记录术中麻醉药用量、脑电分级情况、患者恢复情况及术后不良反应。结果 A组麻醉深度在预设定目标水平D2～E1的比例明显高于B组(P<0.01)。与B组比较,A组苏醒时间和听从指令的时间明显缩短(P<0.05),术后恶心呕吐发生率明显降低(P<0.05)。两组麻醉药用量差异无统计学意义,均无术中知晓发生。结论 Narcotrend监测有利于调控麻醉深度,缩短患者复苏时间,降低术后恶心呕吐发生率。

Objective To investigate the value of Narcotrend monitoring for neuroanesthesia in brain tumor resection.Methods Fifty ASA Ⅰ or Ⅱ patients,scheduled for elective craniotomy and resection of brain tumors under general anesthesia were randomized into 2 groups：Narcotrend monitoring（group A） and standard practice group（group B）.Propofol was administered by TCI with a target plasma concentration of 2.0-6.0 μg/ml,remifentanil was infused at 0.05-0.30 μg·kg-1·min-1 and cisatracurium 1 μg·kg-1·min-1 for anesthesia maintenance.Group A maintained NT between D2-E1 levels by adjusting the propofol TCI rate and remifentanil infusion rate.Group B adjusted the two drugs according to the clinical practice.The consumption of intraoperative anesthetics,Narcotrend values,patient recovery and complications were recorded.Results The distribution of the Narcotrend substage within the target level（D2-E1） was 78% in group A,which was higher than that of group B（56.4%）（P〈0.01）.Recovery times were significantly shorter in group A than that in group B（P〈0.05）.The rate of PONV was significantly lower in group A compared with group B.The propofol and remifentanil consumption were similar between groups.There was no awareness in both groups.Conclusion Narcotrend monitoring is a good method to control anesthesia depth and reduce recovery time and PONV in neurosurgical anesthesia.