笑气-氧气吸入在口腔颌面外科手术中镇静对Narcotrend指数的影响

The influence on narcotrend index of sedation by nitrous oxide and oxygen inhalation in the Oral-Maxillafical surgery

目的采用Narcotrend麻醉深度监测仪在笑气对口腔颌面外科手术镇静时进行监测,观察笑气镇静时是否引起Narcotrend指数(NI)变化。方法选择择期接受口腔颌面外科手术的患者134例,年龄6岁~66岁,ASA分级I^II级。随机分为两组:笑气+局麻组(笑气组,n=67)和单纯局麻组(对照组,n=67)。分别观察笑气组和对照组患者术中配合情况,并记录笑气组患者入室即刻T1、平静5分钟后T2、笑气-氧气吸入起效时T3、消毒时T4、局麻时T5、手术开始T6、术中T7、手术结束时T8以及术后5分钟时T9的心率、血压、血氧饱和度、呼吸频率和NI指数及对照组患者在上述对应时间点的心率、血压、血氧饱和度和呼吸频率。结果笑气组患者对器械敲打、疼痛等刺激无不适感,容易接受治疗并且配合手术完成。对照组有6位患者在术中表示对器械敲打、疼痛等刺激产生不适感,但也能够配合完成手术。笑气组血氧饱和度高于对照组,呼吸频率低于对照组,差异均有统计学意义(P<0.05);两组中心率、血压相差不明显,仅个别时间点有显著性差异(P<0.05);NI指数无明显变化,基本在清醒范围内。结论笑气-氧气吸入镇静技术可改善手术过程中患者的紧张焦虑状况,对血压、心率、血氧饱和度、呼吸频率以及NI指数无明显影响。

Objective To determine whether narcotreud index changes during nitrous oxide and oxygen inhalation sedation in the Oral -Maxillafical surgery. Methods One hundred and thirty four patients aged between 6 years and 66 years old, male or female, were selected in the Oral -Maxillafical surgery.. All patients qualified to ASA physical status of I or II were divided randomly into two groups ： nitrous oxide ＋ local anesthesia group （nitrous oxide group ,n=67） and local anesthesia group （controll group, n=67）. The patient＇s operation with the doctor in surgery was observed in nitrous oxide group and controll group respectively. In all patients, the heart rate, blood pressure, respiratory rate, oxyhemoglobin saturation were recorded during the operation, and above indices in two the groups were compared in the following time points：T1： right after entering the operative room; T2： after five minutes quiet in the operative room; T3： the OAMS score reached 4 under nitrous oxide inhalation; T4： sterilization; T5： local anesthesia; T6： surgery began; TT： in the process of surgery; T8： surgery completed; Tg： five minutes after the completion of surgery. Narcotrend Index in nitrous oxide group was recorded in above time points as well, and compared with the control value. Results In nitrous oxide ＋ local anesthesia group, inhalation of nitrous oxide in the dose of cough and vomiting reflexes remaining, effectively controlled patients feeling of fear, anxiety and pain, which made patients relaxed and easy to accept treatment, and the surgery proceeding more smoothly. In regular local anesthesia group, there were six patients uncomfortable about the pain resulting from the sound of dental drilling, and instrumental hammering, but they were able to go through the surgery as well. the oxyhemoglobin saturation in nitrous oxide ＋ local anesthesia group was higher than that of regular local anesthesia group , respiratory rate in nitrous oxide ＋ local anesthesia group was decreased than that of regular local anesthesia group, there was significant difference in oxyhemoglobin saturation and respiratory rate between the two groups （P〈0.05）.There was significant difference in heart rate and blood pressure in several time points between the two groups （P〈0.05）. Narcotrend Index compared with normal value, there was no apparent change. Conclusion Sedation by nitrous oxide and oxygen inhalation in the Oral - Maxillafical surgery can significantly improve patients＇ anxiety status, which is benefit to proceeding surgery.Nitrous oxide and oxygen inhalation is no apparent influence on patients＇ vital signs, such as heart rate, blood pressure, oxyhemoglobin saturation, respiratory rate and narcotrend index.