Narcotrend监测在腔镜微创手术快通道麻醉中的应用

Application of Narcotrend monitoring in fast-track anesthesia for minimally invasive laparoscopic surgery

目的观察Narcotrcnd监测用于腔镜微创手术快通道麻醉的临床效果。方法择期行妇科腹腔镜手术患者60例，ASAI或Ⅱ级，采用随机数字表法分为Narcotrcnd监测组（N组）和对照组（c组），每组30例。两组均以丙泊酚、瑞芬太尼、阿曲库铵行麻醉诱导和麻醉维持并行Narcotrcnd监测，N组以Narcotrcnd监测结果判断麻醉深度并调整用药，使Narcotrcnd指数州D维持在DI-E0水平，C组依据临床体征和临床经验调节麻醉用药。记录两组麻醉诱导前（Ta）、插管后5rain（T2）、手术开始时m）、CO2气腹后lrain（1r4）、手术结束时（L）的平均动脉压（MAP）、心率（HR）、Narcotrcnd指数（M）；记录麻醉药用量、手术时间、麻醉时间、苏醒时间、拔管时间；记录苏醒期躁动、恶心呕吐等不良反应及术中知晓发生情况。结果T2、T3、T4和T5时C组NI、MAP、HR明显低于N组（P〈0．01或0．05）。与C组比较，N组丙泊酚用量明显减少（P〈0．01），N组患者苏醒时间和拔管时间均明显缩短（P〈0．01）。两组患者苏醒期躁动、恶心呕吐差异无统计学意义（P〉0．05），均无术中知晓发生。结论Narcotrcnd监测用于腔镜微创手术快通道麻醉，有利于调控麻醉深度，实现精确麻醉，减少丙泊酚用量，缩短苏醒时间和拔管时间，加快麻醉恢复。

Objective To study the effect of Narcotrend monitoring in fast-track anesthesia for minimally in- vasive laparoscopic surgery. Methods Sixty patients （ASA I or 11） undergoing elective gynecologic laparoscopic surgery were randomly divided into two groups： Narcotrend monitoring group （group N） and control group （group C）, with 30 cases in each group. All patients were induced and maintained with propofol, remifentanil and atracurium while monitored by Narcotrend. Group N maintained NT between D1-E0 levels by adjusting the propofol TCI rate and remifentanil infusion rate. Group C adjusted the two drugs according to the clinical signs and the clinical practice. Mean arterial pressure （MAP）, heart rate （HR） and NI in two groups were recorded at time points： before induction （T~）, 5 minutes after intubation （T2）, the beginning of operations （T3）, 1 min after CO2 pneumoperitonenm （T4）, the end of operations （%）. The anesthetic dosage, operation time, anesthesia time, recovery time, and extubation time were re- corded. The intraoperative awareness and the adverse reactions during recovery such as emergence agitation, nausea and vomiting were recorded. Results NI, MAP and HR were significantly lower in group C than group N at T2, T3, 14 and Ts （P〈0.01 or 0.05）. Compared with group C, the dosage of propofol in group N was decreased significantly （P〈0.（）I）, recovery time and extubation time in group N was significantly shortened （P〈0.01）. There was no statistical- ly significant difference in emergence agitation, nausea and vomiting between the two groups （P〉0.05）. There was no intraoperative awareness in both groups. Conclusion Narcotrend monitoring in fast-track anesthesia for minimally invasive laparoscopic surgery is useful for optimizing the anesthesia depth and achieving precise anesthesia. It can speed up recovery by reducing the dosage ofpropofol, recovery time and extubation time.