不同Narcotrend麻醉深度指数用于门诊无痛人流手术中的临床观察

目的研究不同Narcotrend麻醉深度指数(NI)在门诊无痛人流手术麻醉中的临床效果。方法 150例择期在丙泊酚-瑞芬太尼静脉麻醉下行无痛人流的门诊病人,年龄18～40岁,ASAI～Ⅱ级,随机分为3组,每组50例:A组Narcotrend麻醉深度指数(NI)预期值:27～36,对应的脑电图分级(NTS):E0;B组NI预期值为37～46对应的NTS:D2;C组NI预期值为47～56对应的NTS:D1。3组麻醉诱导及维持药物均为丙泊酚和瑞芬太尼,静脉推注丙泊酚-瑞芬太尼至预期的NI值后开始手术。记录手术中丙泊酚-瑞芬太尼总量;HR、MAP、Sp02的变化;体动反应;术后改良5min警觉/镇静评分(OAA/S评分);患者达到离院标准的时间。结果 A组丙泊酚-瑞芬太尼用量明显多于B组、C组(P<0.05);HR、MAP、Sp02的变化A组与B组、C组及基础值比较显著降低(P<0.05);体动不良反应发生率C组明显多于A组、B组(P<0.05);术后改良5minOAA/S评分中A组清醒率明显低于B组、C组,留观时间A组显著长于B组、C组(P<0.05)。结论 Narcotrend麻醉深度监测可反馈指导门诊无痛人流手术的麻醉用药,能有效地维持术中血流动力学稳定,防止术中知晓,并能加快病人术后意识恢复,其适宜的NI值为37～46。

Objective To evaluate the clinical effects of different Narcotrend index in anesthesia of outpatients undergoing uterine dilatation and curettage surgery. Methods One hundred and fifty ASAI-II patients, age 18-40, undergoing uterine dilatation and curettage surgery under propofol- remifentanil anesthesia were studied. They were randomly assigned to expected NI of27-36, NTS： E0 （groupA, n=50） or expected NI of 37-46, NTS： D2 （groupB, n=50） or expected NI of47-56, NTS： D1 （groupC, n=50）. Remifentanil and propofol were used as induction and maintenance drugs, when the NI was achieved a expected value after induction of anesthesia, the operation was beginning. The total amount of propofol-remifentanil; change of HR, MAP, SpO2 during operation; body dynamic response; improved OAA, S value of 5 minutes after operation; the time when patients reached the standard for discharge from hospital were recorded. Results The amount of propofol-remifentanil used and time of recovery were significantly more in groupA than that in groupB and groupC （P〈0.05）. During induction and maintenance of anesthesia, the decrease level of HR, MAP, SpO： were more significantly in groupA than that in groupB and groupC （P〈0.05）. The adverse effects of body dynamic response were significantly more in groupC than that in groupA and groupB （P〈0.05）. The rate of awake was significantly less in groupA than that in groupB and group C （P〈0.05） （5min improved OAA/S after operation）. Conclusion Narcotrend index monitoring can infrom the dose of anaesthetic in outpatients undergoing uterine dilatation and curettage surgery, keep hemodynamics stable and make recovery quicker, the approapiate value of NI for 37-46.