Narcotrend监测在老年患者全身麻醉中的应用

Application of Narcotrend monitoring in elderly patients with general anesthesia

目的研究Narcotrend(NT)监测在老年患者全身麻醉中应用的临床效果。方法择期行腹腔镜胆囊切除术(LC)老年全麻患者60例,采用随机数字表法将患者均分为NT监测组(N组)和常规对照组(C组)。以丙泊酚靶控输注(TCI)进行麻醉诱导和维持。术中N组丙泊酚TCI浓度依据NT进行调控,C组丙泊酚TCI浓度依据患者的BP、HR等生命体征进行调控。记录两组麻醉时间、手术时间、苏醒时间、拔管时间及麻醉后PACU驻留时间;记录丙泊酚的用量和患者围术期躁动、恶心呕吐、术中知晓等的发生率。结果与C组比较,N组患者的苏醒时间、拔管时间及PACU驻留时间明显缩短(P<0.05);丙泊酚用量明显减少(P<0.01)。围手术期躁动、恶心呕吐、术中知晓等的发生率差异无统计学意义。结论老年全麻患者使用NT行麻醉深度监测,能减少丙泊酚用量,缩短苏醒时间,减少PACU驻留时间。

Objective To discuss the feasibility of Narcotrend （NT） monitoring application in elderly patients with general anesthesia. Methods Sixty elderly patients who underwent elective laparoscopic cholecystectomy （LC） with general anesthesia were randomly and double-blindly divided into the NT surveillance group （group N, n=30） and regular monitoring control group （group C, n =30）. Anesthesia was induced and maintained with target control infusion（TCI）of propofol. In group C, the concentration of propofol was adjusted and controlled based on the patient＇s BP, HR, et al. Vital signs and drug using experience at ordinary times. In group N, the concentration of propofol was adjusted and controlled according to the Narcotrend index （NTI）. Anesthesia time, operation time, awakening time, extubation time and post-anesthesia care unit （PACU） residence time were recorded. The dosage of propofol and incidences of related complications such as dysphoria, nausea and vomiting, awareness perioperatively were recorded. Results Compared with group C, the awakening time, extubation time and PACU residence time in group N were significantly shortened （P〈0. 05） ; and the dosage of propofol was decreased significantly （P〈0. 01） in group N. There was no statistically significant difference between the two groups for the incidence of related complications perioperatively. Conclusion Elderly patients with general anesthesia monitoring depth of anesthesia using NT, can reduce the dosage of propofol, shorten recovery time and reduce the PACU stay time.