Narcotrend监测系统用于腹腔镜胆囊切除术的临床观察

Clinical observation of narcotrend monitoring system in laparoscopic cholecystectomy

目的评价Narcotrend监测系统在腹腔镜胆囊切除手术中监测麻醉镇静深度的实用性。方法选择腹腔镜胆囊切除手术气管内全麻患者40例,随机分成Narcotrend组(N组)和常规组(C组),每组各20例。N组手术采用Narcotrend监测系统,C组不使用。记录两组患者诱导前(T0)、诱导后(T1)、CO2气腹后5 min(T2)、CO2气腹后30 min(T3)、术毕时(T4)、清醒拔管后(T5)的平均动脉压(MAP)、心率及Narcotrend指数的变化和麻醉用药量。术毕记录自主呼吸恢复时间、苏醒时间、定向力恢复时间、清醒拔管时间、视觉模拟评分(VAS)及术中知晓发生率。结果 T2时两组MAP与T0比较,差异有统计学意义(P<0.05);N组丙泊酚用量显著少于C组(P<0.05),而且术毕苏醒时间、定向力恢复时间、自主呼吸恢复时间及清醒拔管时间均明显短于C组(P<0.05);两组VAS差异无统计学意义(P>0.05),且均无术中知晓发生。结论 Narcotrend监测系统可以有效监测患者的意识状态和麻醉深度,使血流动力学更加平稳,麻醉药物的用量更加精准,并能改善麻醉苏醒的质量。

Objective To evaluate the feasibility of Narcotrend monitoring system in monitoring the depth of anaesthesia for patients received laparoscopic cholecystectomy. Methods 40 patients whom received laparoseopic eholecystectomy with endotracheal intubation general anesthesia were selected and randomly divided into Narcotrend group （N group） and regular group（C group）,with 20 cases in each group.the N group adopted Narcotrend monitoring system whereas the C group not adopted Narcotrend monitoring system.The changes of mean arterial blood pressure （MAP）, heart rate（HR）, the numerical value of Narcotrend and the dosage of anesthetics were recorded at the following time points respectively： instantly before anesthesia induction（T0）,immediately after anesthesia induction（T1）,5 minutes after CO2 pneumoperi- toneum（T2）,30 minutes after C02 pneumoperitoneum（T3）,immediately after operation（T4） and instantly after conscious tra- cheal extubation （Ts）.After the operation,the recovery times of autonomous respiration,recovery time of consciousness,re- covery time of orientation,time of conscious tracheal extubation,visual analogue scale （VAS） and the incidence of intra- operative awareness were noted down. Results There was a statistical significance of MAP between the two groups in T2 compared to T0（P〈0.05）.The dosage of propofol in N group was significantly less than that of C group（P〈0.05）.The recovery time of autonomous respiration,recovery time of consciousness,recovery time of orientation,time for conscious tracheal extubation in N group were all shorter than those of C group （P〈0.05）.The difference of VAS between the two groups was not statistically significant（P〉0.05）.No cases of intraoperative awareness was found in the two groups. Con- clusion Narcotrend monitoring system can effectively monitors the patient＇s state of consciousness and the depth of anesthesia,keeps smooth and steady haemodynamics and the dosage of anesthetic drugs more accurate,as well as im- proves the quality of the anesthetic revival.