Narcotrend监测丙泊酚-瑞芬太尼全凭静脉麻醉深度在妇科腹腔镜手术中的应用

Narcotrend monitor for the assessment of anesthetic depth during total intravenous anesthesia with propofol-remifentanil in gynecological laparoscopic surgery

目的探讨Nareotrend监测（NT）丙泊酚瑞芬太尼全凭静脉麻醉（total intravenous anesthesia，TIVA）深度在妇科腹腔镜手术中的应用效果。方法择期美国麻醉医师协会（ASA）Ⅰ～Ⅱ级、于全身麻醉下行妇科腹腔镜手术患者110例，按照随机数字表格随机分为2组：NT麻醉深度监测组（N组）与对照组（J组）（每组55例）。所有患者采用统一标准麻醉诱导；术中全麻维持以丙泊酚瑞芬太尼恒速输注：N组采用NT调节麻醉深度，J组根据患者心率、血压及体动调节麻醉深度。分别于入室、插管即刻、气腹前、气腹后、气腹结束、呼唤睁眼、气管导管拔管、完成指令等8个时间点观察记录平均动脉压（MAP）、心率（HR）、脉搏氧饱和度（SpO2）；记录NT分级（NTS）、NT指数（narcotrend index，NTI）、镇静药总量、镇痛药总量、肌松药总量、苏醒时间、拔管时间。结果两组患者在术后恢复室均有术中知晓发生；两组患者术前一般情况比较，均无统计学意义；N组较J组MAP、HR变化更为平稳（P〈0．05），SpO2无明显变化。丙泊酚／瑞芬太尼用量比较，N组[（320±54）mg／（28±11）μg]较J组[（450±80）mg／（41±11）μg]减少（P〈0．05）；两组苏醒时间肢管时间比较，N组[（8±4），（15±5）]min较J组[（12±6）／（19±9）]min降低（P〈0．05）。结论在丙泊酚端芬太尼恒速输注条件下，采用NT麻醉深度监测仪行妇科腹腔镜手术患者静脉麻醉深度监测，较传统凭经验给药更安全，能减少不必要地过量使用静脉全身麻醉药物。

Objective To investigate the anesthetic state during propofol-remifentanil anesthesia （TIVA） with Narcotrend Monitor （NT） in gynecological laparoscopic surgery. Methods 110 patients （ASA Ⅰ or Ⅱ ） undergoing gynecological laparoscopic surgery were randomized into two groups： anesthetic depth measured with NT group （Group N） and the control group （Group J） （n = 55）. All were treated with standard induction of anesthesia, with intraoperative propofol-remifentanil TIVA to maintain. Group N adjusts the depth of anesthesia according to NT. Group J of adjusts the depth of anesthesia according to patients＇ heart rate, blood pressure and body automatically, et al. NT grading （NTS）, the NT index （narcotrend index, NTI）, mean arterial pressure （MAP）, heart rate （HR）, and pulse oxygen saturation （SpO2） were recorded during induction, intubation, before pneumoperitoneum, after pneumoperitoneum, end of pneumoperitoneum, opening of eyes, extubation of endotracheal tube, and complete instructions （eight time points）. The total amount of sedatives, analgesics, total muscle relaxant, awakening time, time to extubation, and intraoperative awareness were observed and recorded. Results There were no reports of intraoperative awareness in the post-anesthetic care unit in each group. There were no statistical significant differences in demographic characteristics or perioperative factors between group N and group J （P〉0.05）. Compared with group J, the efficacy in maintenance of anesthesia was no significant difference in two groups （P〉0.05）. And SpO2 no significant change （P〉0.05）. However, MAP, HR changes were more stable, and the infusion rate of propofol-remifentanil had been decreased in group N： group N（320±54） mg/（28±1 ） μg] vs. group J[（450±0） mg/（41 ±11 ） μg] （P〈0.05）. The time of analepsia was significant difference in two groups： group N （8±） min vs. group J （12± ） min, and the patients of group N analepsiaed quickly and completely： group N （15±5） min vs. group J （19±9） min （P〈0.05）. Conclusions NT used as monitoring the depth of propofol-remifentanil TIVA was clinical significance in the safety of gynecological laparoscopic surgery. It could reduce unnecessary excessive use of intravenous general anesthetics.