Narcotrend监测在老年无痛肠镜麻醉深度监测中的应用

Application of a narcotrend-assisted anesthesia in-depth monitor in the elder patients in painless colonoscopy

目的:探讨Narcotrend监测在老年无痛肠镜检查中芬太尼-丙泊酚全凭静脉麻醉深度监测的应用。方法:择期无痛肠镜诊疗的患者120例,年龄60～70岁,ASAⅠ～Ⅱ级,随机分为麻醉趋势组(N组)和临床组(C组),每组60例。两组患者均接受芬太尼-丙泊酚全凭静脉麻醉,N组根据麻醉趋势指数(NI)调节麻醉深度;C组根据临床体征调节麻醉深度。分别记录两组的血流动力学和NI,诱导、检查、苏醒、定向力恢复及留观时间,丙泊酚用量、不良反应及术后患者的视觉模拟评分(VAS)。结果:N组平均动脉压在麻醉诱导入睡后和插镜时降幅小(P<0.05),NI在插镜时降幅小(P<0.05)。N组丙泊酚用量减少(P<0.05),苏醒、定向力恢复及留观时间缩短(P<0.05),不良反应发生率降低(P<0.05)。两组患者术后VAS评分差异无统计学意义(P>0.05)。结论:在芬太尼-丙泊酚静脉麻醉老年肠镜检查中,Narcotrend监测能减少丙泊酚的用量及不良反应的发生,使血流动力学更平稳,同时缩短患者恢复时间。

Objective To investigate the application of a narcotrend-assisted anesthesia in-depth monitor in the elder patients undergoing painless colonoscopy with fentanyl-propofol anaesthesia. Methods One hundred and twenty ASA Ⅰto ASAⅡ patients aged 60 to 70 years undergoing painless colonoscopy were randomized into nareotrend （N） group and clinical practice （C） group. All patients received total intravenous anesthesia with fentanyl-propofol. The patients in group N were adjusted anesthesia in-depth according to nareotrend index （NI）, and the patients in group C were adjusted anesthesia in-depth according to clinical symptoms. Changes of hemodynamics, NI, durations of inducement, surgeries, emergence, orientation recovery and observation were recorded. The propofol doses, incidence of adverse effects and visual analoguc scalc （VAS） were also recorded. Results In comparation with group C, the reduction level of MAP was less at T1 and T2 （P 〈 0.05）, so did the reduction of NI at T2 （P 〈 0.05） in group N. The dose of propofol used was less, the durations of emergence, orientation recovery and observation were shorter （P 〈 0.05）, and the incidences of adverse effects were also less （P 〈 0.05） in group N than thqse in group C. No differences in postoperative VAS were found between these two groups （P 〉 0.05）. Conclusions Narcotrend-assisted anesthesia in-depth monitor in the elder patients undergoing painless colonoscopy contributes to reducing the dose of propofol and adverse effects, and contributes to achieving steady-state hemodynamics and shortening the duration of recovery after total intravenous anesthesia with fentanyl- propofol.