Narcotrene 指数指导异丙酚联合不同镇痛药物在肠镜检查中的应用价值

The application of Narcotrend index on guiding propofol combined with different analgesic drugs on the colonoscopy

目的： Narcotrene 指数（Narcotrene ineex，NI）指导异丙酚联合不同镇痛药物在肠镜的检查，评估不同的镇痛药物的应用效果和安全性。依据 NI 指导的麻醉深度，调整肠镜检查时异丙酚的效应室浓度。方法240例门诊肠镜诊疗患者，根据异丙酚联合不同镇痛药物随机分为4组（A 组：地佐辛＋异丙酚；B 组：芬太尼＋异丙酚；C 组：舒芬太尼＋异丙酚；D 组：生理盐水＋异丙酚），每组60例。在手术的不同阶段，将 NI 控制在56-65和66-75两个不同的麻醉深度内，记录各组患者麻醉前（T1）和睫毛反射消失时（T2）、插镜过肛门时（T3）、插镜达回盲部时（T4）及退镜完毕时（T5）5个时间点的生命体征[平均动脉压（MAP）、心率、呼吸频率及血氧饱和度（SpO2）]、诱导时间、插镜时间和苏醒时间以及手术中患者的体动病例数、呼吸抑制病例数，分析各组患者的 VAS 评分及异丙酚的总用量。结果4组患者在 T2、T3、T4时与 T1比较，MAP、心率、呼吸频率均下降；A、B、C 组与 D 组比较，MAP、心率、呼吸频率均有不同程度的下降[MAP ：F组内=26.793、P 〈0.05，F交互=6.532、P 〈0.05，F组间=7.574、P 〈0.05；心率：F组内=21.428、P 〈0.05，F交互=6.316、P 〈0.05，F组间=5.431、P 〈0.05；呼吸频率：F组内=14.226、P〈0.05，F交互=5.531、P 〈0.05，F组间=7.986、P 〈0.05]；体动发生例数及呼吸抑制例数方面，与 D 组比较，A 组明显减少（A 组患者体动发生例数及呼吸抑制例数分别为2、2例，D 组分别为14、14例），两组比较差异均有统计学意义（P 均〈0.01）；与 D 组比较，A、B、C 组 VAS 评分及异丙酚总用量明显减少[A、B、C、D 组 VAS 评分及异丙酚总用量分别为：（1.20±0.72）分和（148.40±10.53）mg、（1.88±0.88）分和（178.85±18.59）mg、（1.65±0.74）分和（166.68±16.22）mg、（2.35±1.10）分和（227.33±28.66）mg]，组间比较差异有统计学意义（F 值分别为18.038、177.399，P 均〈0.05）。结论利用 Narcotrene 监测仪实时监测异丙酚联合不同的镇痛药进行肠镜检查可明显减少患者麻醉药物的用量，降低患者并发症的发生率，从而增进了患者的舒适度。

Objective To explore the clinical application of Narcotrene Ineex（ NI）on guieing the usage of propofol combinee with eifferent analgesic erugs at colonoscopy examination,in oreer to evaluate the application ane clinical safety of the eifferent analgesic erugs. Basee on NI guieance,propofol effect-site concentration was aejustee euring colonoscopy. Methods Two huneree ane forty patients with colonoscopy were selectee as our subjects. They were eivieee into 4 groups accoreing to propofol combinee with eifferent analgesic erugs（A group：eezocine ＋ propofol;B Group：fentanyl ane propofol;C Group：Shu fentanyl ane propofol;D groups：saline ＋ propofol）ane each group has 60 cases. At eifferent stages of surgery,NI was control within 56- 65 or 66 - 75 in terms of anesthesia eegree. The life ineices（ mean arterial pressure（ MAP）,heart rate, respiratory rate（RR）ane oxygen saturation（ SpO2 ））,ineuction time,insert the mirror ane surgical time ane recovery time ane cases with boey movement,the cases of respiratory eepression were recoreee. The analysis of each group of patients with VAS scores ane the total amount of propofol the patients were recoreee at 5 time points（before anesthesia（T1）ane eyelash reflex time（T2）,insertee through the anus mirror（T3）,when insertee mirror up to the ileocecal（T4）ane the back mirror finish（T5））. Results MAP,heart rate,respiratory rate of patients in four groups at T2,T3 ane T4 time point were eecreasee than that in T1. Comparee with D group, MAP,heart rate,respiratory rate of patients in A,B ane C groups eecreasee at eifferent eegrees（MAP：F within group = 26. 793,P 〈 0. 05;F interaction = 6. 532,P 〈 0. 05;F between group = 7. 574,P 〈 0. 05;Heart rate：F within group = 21. 428,P 〈 0. 05;F interaction = 6. 316,P 〈 0. 05;F between group = 5. 431,P 〈 0. 05;Respiratory rate：F within group = 14. 226,P 〈 0. 05;F interaction = 5. 531,P 〈 0. 05;F between group= 7. 986,P 〈 0. 05）. The case of boey movement ane breathing inhibition in A group were 2 ane 2 case,less than that in D group（14,14 cases respectively;P 〈 0. 01）. VAS score ane the total amount of propofol in A,B, C groups were（1. 20 ± 0. 72）points ane（148. 40 ± 10. 53）mg;（1. 88 ± 0. 88）points ane（178. 85 ± 18. 59） mg;（1. 65 ± 0. 74）points ane（166. 68 ± 16. 22）mg,less than that in D group（（2. 35 ± 1. 10）points ane （227. 33 ± 28. 66）mg）,ane the eifferences was statistically significant（ F = 18. 038,177. 399;P 〈 0. 05）.Conclusion During colonoscopy,Narcotrene real-time monitoring of propofol combinee with eifferent analgesics can significantly reeuce the amount of narcotic erugs,shortee recovery time,reeuce the incieence of complications in patients,ane thus enhancing patient comfort .