Narcotrend监测调控快速康复外科结直肠手术麻醉深度的效果

EFFECT OF NARCOTREND IN MONITORING THE DEPTH OF ANESTHESIA ON PATIENT UNDERGOING ELECTIVE FAST- TRACK LAPAROSCOPIC COLORECTAL SURGERY

目的探讨Narcotrend监测调控快速康复外科结直肠手术麻醉深度的效果。方法选择快速康复外科择期腹腔镜结直肠癌根治术患者40例,年龄39~72岁,ASAⅠ（Ⅱ级,随机分为Narcotrend监测组（NCT组）和常规监测组（对照组）,每组20例。2组均行胸段硬膜外麻醉,血浆靶控输注丙泊酚与静脉注射瑞芬太尼气管插管全身麻醉,NCT组根据Narcotrend指数（Narcotrend Index,NI）调节丙泊酚用量使麻醉深度维持在NI值64-37水平,对照组以患者临床体征与麻醉医生经验调节麻醉深度。记录麻醉诱导前（T0）、气管插管前即刻（T1）、手术开始前（T2）、手术气腹后2 min（T3）、手术气腹后1 h（T4）、手术结束（T5）时的平均动脉压（MAP）、心率（HR）和NI,术中丙泊酚和瑞芬太尼用量,拔管时间,拔管后10 min、30 min的RSS镇静评分及VRS镇痛评分,复苏期不良事件和术中知晓情况。结果与T0时间点相比,NCT组和对照组T1、T2时间点MAP与HR均显著降低（p〈0.05）。T1、T2、T3时间点对照组MAP显著低于NCT组（p〈0.05）。T1、T2、T3时间点对照组NI显著低于NCT组（p〈0.05）。NCT组术中丙泊酚用量明显少于对照组（p〈0.05）,2组瑞芬太尼用量无明显差别（p〉0.05）,NCT组拔管时间明显短于对照组（p〈0.05）。2组拔管后10 min、30 min的RSS镇静评分、VRS镇痛评分及复苏期不良事件发生率均无显著差异（p〉0.05）,均无发生术中知晓。结论运用Narcotrend监测调控快速康复外科结直肠手术麻醉深度可以使围术期血流动力学更平稳,减少丙泊酚用量,缩短麻醉复苏时间,提高麻醉质量,为个体化麻醉处理提供一种较好的监测方法。

Objective To investigate the effect of Narcotrend in monitoring the depth of Anesthesia on patient undergoing elective fast- track laparoscopic colorectal surgery. Methods Forty patients aged 39- 72 years undergoing elective fast- track laparoscopic colorectal surgery were randomly divided into two groups（ 20 in each group）. In narcotrend control group（ NCT group） Narcotrend Index（ NI） range 64- 37 was set as feedback control in anesthesia depth. Control group used traditional clinical sign for anesthesia depth control. All patients received thoracic epidural anesthesia first,and then started general anesthesia with plasma target- controlled infusion of propofol and continuous infusion of remifentanil. The patient＇s mean artery pressure（ MAP） and heart rate（ HR） and NI were recorded before anesthesia（ T0）,before intubation（ T1）,before skin incision（ T2）,2 min after pneumoperitoneum（ T3）,1 hour after pneumoperitoneum（ T4）,and at the end of the surgery（ T5）. The total dose of propofol and remifentanil,the time needed from the end of the operation to extubation,the Ramsay scores and verbal rating scales（ VRS） recorded at 10 min and 30 min after extubation,and the adverse events and intraoperative awareness were assessed and recorded. Results MAP and HR in both groups decreased significantly at T1,T2 compared to those at T0（ p〈0. 05）. NCT group make MAP more stablely than Control group at T1、T2、T3（ p〈0. 05）. NI was lower in Control group than NCT group at T1、T2、T3（ p〈0. 05）. NCT group reduced the total dose of propofol and shorten the time for extubation（ p〈0. 05）. Conclusion Use of Narcotrend in monitoring the depth of Anesthesia on patient undergoing elective fast- track laparoscopic colorectal surgery can lead to hemodynamic stability,less anaesthetic consumption,early extubation and accurately control of anesthesia depth.