Narcotrend指数在学龄前儿童腹腔镜手术麻醉中的应用与比较

Comparative evaluation of Narcotrend index in preschool children during laparoscopic surgery

目的探讨Narcotrend index、Bispectral index及Entropy index在学龄前儿童腹腔镜手术中的敏感性。方法选择120例腹腔镜择期手术患儿,分Narcotrend指数组(NTI组)、BIS指数组(BIS组)、Entropy指数组(E组)及对照组(D组),每组30例。静注麻醉诱导药物,插入气管导管后行机械通气,吸入七氟烷复合输注瑞芬太尼进行维持。记录入室到出室之间各观察阶段的MAP、Sp O2、HR、NTI值、BIS值、熵指数值;记录手术时长、停药至自主呼吸恢复时间、计算七氟烷与瑞芬太尼用量。结果 N组中,T3、T4及T9与T2时刻比较,Narcotrend index指数值上升(P<0.05),且停药至自主呼吸恢复时间NTI组较其余组缩短(P<0.01);NTI组七氟烷及瑞芬太尼用量与其余组比较,用量减少(P<0.05)。结论 Narcotrend Index应用于学龄前儿童腹腔镜手术中的麻醉深度敏感性略优于Bispectral index及Entropy index,使用Narcotrend index进行麻醉深度监测,更能够减少麻醉药物用量,缩短苏醒时间,PRST波动小。

Objective To explore the sensitivity of the Narcotrend index, Bispectral index and Entropy index in the preschool children during subjected to laparoscopic surgery. Methods 120 cases of children undergoing elective laparoscopic surgery were chosen and were assigned to 4 groups, Narcotrend index group （N group, n=30）, Bispectral index （B group, n=30）, Entropy index （E group, n=30） and control group （D group, n =30）. After standard intravenous anesthesia induction, the endotracheal tube was inserted for mechanical ventilation,and then inhaled sevoflurane and infused remifentanil to maintain anesthesia. The MAP, SpO2, HR, NTI, BIS, entropy index were recorded in each observation stage between entrance in and out operation room. The operation time, time from stopping infusion drugs to breathe spontaneously were recorded. The dosage of sevoflurane and remifentanil was calculated. Results In N group, N value was increased in T3 T4 and T9 moment than in T2 moment （all P values〈0.05）. Compare with other groups, the recovery time of spontaneous breathing of NTI group was shortened （all P values〈0.05）, and the dosage of sevoflurane and remifentanil of NTI group was reduced （all P values〈0.05）. Conclusion In preschool children for laparoscopic surgery, Narcotrend index hand the advantage to both bispectral index and entropy index in monitoring anesthesia depth sensitivity, as well as the smaller dosage of anesthetic drugs, shorten the time of awakening, smaller PRST fluctuations.