氯胺酮对丙泊酚复合瑞芬太尼麻醉Narcotrend指数监测的影响

Effects of different dosages of ketamine on Narcotrend index monitoring under propofol-remifentanil anesthesia

目的观察丙泊酚复合瑞芬太尼麻醉时氯胺酮不同剂量对Narcotrend指数(NI)及分级的影响。方法 ASA I^II级择期拟行气管插管全身麻醉的患者100例,随机分为I^V组,分别对应0.2、0.5、1.0和2.0mg/kg的氯胺酮及生理盐水。靶控输注丙泊酚和瑞芬太尼进行麻醉诱导及维持,气管插管后待麻醉深度稳定10 min,没有外科刺激时,静脉注射氯胺酮或生理盐水。连续观察15 min血流动力学及NI的变化并记录。结果给药前各组的NI无差异。给药后Ⅰ组与Ⅴ组的NI在各个时间点均无差异;Ⅱ组、Ⅲ组和Ⅳ组与Ⅴ组相比,NI明显升高(P<0.01),但Ⅱ组的Narcotrend分级并无变化,而Ⅲ组和Ⅳ组的NI明显升高并使Narcotrend分级显著提高。结论在丙泊酚复合瑞芬太尼静脉全身麻醉时,随着剂量的增加,氯胺酮将增加NI的数值,1.0 mg/kg及更大剂量的氯胺酮改变了Narcotrend分级,干扰Narcotrend对麻醉深度的评价,可能导致麻醉深度的误判,致使麻醉药物过量,影响麻醉安全。

【Objective】To study the effects of different dosages of ketamine on Narcotrend index（NI） monitoring and grading under propofol-remifentanil anesthesia. 【Methods】100 ASA I^II elective surgery patients with endotracheal intubation general anesthesia were randomly divided into group I to V, and 0.2, 0.5, 1.0, 2.0 mg/kg of ketamine and saline were given respectively. Anesthesia induction and maintenance with target-controlled infusion of propofol-remifentanil. After the tracheal intubation anesthetic depth stable for 10 minutes, with no surgical stimulation, ketamine or saline intravenous used, then continuously monitored and recorded 15min＇ changes of the patients＇ hemodynamic and NI. 【Results】The NI of each group before administration was no difference. No significant difference was observed between group Ⅰ and group V at all time points after administration. Compared group II, group Ⅲ, group IV and groupV, the NI were significantly higher（P 0.01）. In group II the Narcotrend grading did not change, however, in group Ⅲ and group IV, the NI were higher and the Narcotrend grading were significantly improved. 【Conclusion】General anesthesia with propofol-remifentanil in vein, increasingdoses of ketamine will increase the NI value, the 1.0mg/kg and larger dose ketamine will change the Narcotrend grading and interfere Narcotrend index in evaluation of anesthetic depth. These may lead to misjudgment ofthe anesthetic depth, resulting in anesthetic drugs overdose, and influence the anesthesia safety.