Narcotrend在小儿手术全身麻醉中的临床应用

The clinical application of Narcotrend in pediatric anesthesia

目的研究Narcotrend（NT）监测在小儿患者全身麻醉中的临床效果。方法择期美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级、行扁桃体切除术小儿全麻患者60例，采用随机数字表法分为NT监测组（N组）和常规对照组（C组）（每组30例）。以丙泊酚和瑞芬太尼维持麻醉，术中N组丙泊酚浓度根据NT值进行调整，C组丙泊酚浓度依据患者的血压、心率等生命体征进行调控。记录两组的麻醉时间，手术时间、苏醒时间、拔管时间，记录丙泊酚的用量和患者围手术期躁动、恶心呕吐、术中知晓等的发生率。结果两组患者的苏醒时间与拔管时间比较，N组[（6．2±1．1）min、（11．1±1．0）min]较C组[（14．1±1．8）min、（18．5±1．6）min]缩短，差异有统计学意义（P〈0．01）；丙泊酚的用量比较，N组（99±8）mg较C组（148±8）mg明显减少，差异有统计学意义（P〈0．01）；围手术期躁动、恶心呕吐、术中知晓等的发生率差异无统计学意义。结论小儿患者行扁桃体切除手术采用NT监测麻醉深度，较传统凭经验给药更安全，能减少不必要地过量使用静脉全身麻醉药物，缩短苏醒时间。

Objective To evaluate the clinical effects of Narcotrend （NT） monitoring in pediatric general anesthesia. Methods Sixty children（ASA Ⅰ～Ⅱ ） undergoing tonsillectomy surgery were randomized into two groups （n=30）： anesthetic depth measured with NT group （group N） and the control group （group C）. Anesthesia was induced and maintained with propofol and remifentanil. In group N the depth of anesthesia was adjusted according to NT. In group c, propofol concentration was modulated on the basis of the patient＇s blood pressure and heart rate and other vital signs. Anesthesia time, operating time, recovering time and extubation time were recorded. The dosage of propofol and incidences of related complications such as dysphoria, nausea and vomiting, perioperative awareness were recorded. Results The time of analepsia was significant difference in two groups [group N （6.2~1.1） rain vs group C（ 14.1~1.8 ） min（P〈0.01 ）], and the extubation time of group N[ （11.1_＋1.0） min] was significantly shorter t han that in group C [ （18.5＋1.6） mini （P〈0.01）. The dosage of propofol decreaeds significantly in group N [ （99：t：8） mg vs （148 ＋8 ） mg] （P〈0.01）, There was no statistically significant difference between the two groups on the indences of dysphoria, nausea and vomiting, perioperativel awareness. Conclusions In pediatric tonsillectomy surgery, monitoring the depth of anesthesia by NT is a safer way for anesthesia management than empirical administration of anesthetics. It can reduce the incidence of unnecessary excessive use of intravenous anesthetics and shorten the recovery time.