右旋美托咪定与丙泊酚用于腰硬联合麻醉时NTI与OAA/S镇静评分的比较

The correlation between narcotrend index and observeration sedation scale in patients under epidural-spinal anesthesia sedated with dexmedetomidine and propofol

目的比较右旋美托咪定和丙泊酚对腰硬联合麻醉下手术患者术中镇静时Narcotrend麻醉指数(NTI)与警觉/镇静评分(OAA/S)的相关性。方法在腰硬联合麻醉下行择期下腹部手术或下肢手术的患者60例,ASAⅠ~Ⅱ级,分为2组,分别为右旋美托咪定组(D组,n=30)、丙泊酚组(P组,n=30)。在腰硬联合麻醉平面稳定且确保麻醉效果后,D组给予0.6、1.2、2.4 ng·mL^(-1)的右旋美托咪定,P组给予1、2、4μg·mL^(-1)的丙泊酚,每个浓度维持20 min。比较两组患者每个时刻点的OAA/S及NTI。结果丙泊酚组在OAA/S为5、4、3、2、1分时的NTI分别为96(89~97)、83(86~82)、66(63~71)、57(50~61)、46(40~50);右旋美托咪定组在OAA/S为5、4、3、2、1分时的NTI分别为94(78~98)、79(83~75)、45(45~52)、38(34~41)、24(20~30)。结论在使用丙泊酚镇静过程中,NTI与OAA/S的相关性好于右旋美托咪定;右旋美托咪定镇静时,NTI和OAA/S联合使用比单独使用NTI更能反映患者的镇静深度。

Objective To compare the correlation between narcotrend index（NTI） and OAA/S in patients undergoing surgery under epidural- spinal anesthesia sedated with dexmedetomidine and propofol.Methods Sixty patients who were going to receive elective lower abdominal surgery or lower extremity surgery under epidural- spinal anesthesia,ASA Ⅰ-Ⅱ,were divided into two groups,respectively group dexmedetomidine（group D,n=30） and group propofol（group P,n=30）.After the EA anesthesia level became stable and the anesthesia effect ensured,drugs were administered using computer- controlled infusions targeting an plasma concentration of 0.6,1.2,2.4 ng·mL-（-1） for dexmedetomidine or effect-site concentration 1、2、4 μg·ml-（-1） for propofol.The relationship between NTI and OAA/S score was obtained 20 min after changing each drug concentration.Results NTI at OAA/S scores of 5,4,3,2,1 during propofol sedation were 96（89-97）,83（86-82）,66（63-71）,57（50-61）,46（40-50）,respectively.NTI at OAA/S scores of 5,4,3,2,1 during dexmedetomidine sedation were 94（78-98）,79（83-75）,45（45-52）,38（34-41）,24（20-30）,respectively.Conclusion The combination of both NTI and OAA/S score could different to the clinicion evaluating the patient＇s response to sedation than would either tool alone,especially when dexmedetomidine is used.