Narcotrend麻醉深度监测对控制性降压鼻内镜手术患者复苏时间的影响

Effect of Narcotrend Anesthesia Depth Monitoring on the Recovery Time of Patients with Induced Hypotension

目的分析Narcotrend麻醉深度监测(NT)对控制性降压鼻内镜手术患者复苏时间的影响。方法方便选择该院2016年2—6月择期行控制性降压鼻内镜手术患者60例,ASA分级Ⅰ~Ⅱ级,年龄18~60岁,随机均分成N组(Narcotrend监测组)和C组(对照组),N组接受NT监测,C组不进行NT监测,两组术中均行控制性降压。N组根据NT值调节麻醉深度,维持NT分级在D2~E1,NT值在46~20,C组根据麻醉医师经验控制麻醉深度。术中两组均进行常规监测有创血压、心率、脉搏氧饱和度,记录患者麻醉前(T0)、术中降压10 min(T1)、术中降压30 min(T2)、手术结束时(T3)和术毕拔管后10 min(T4)各时间点的心率(HR)和平均动脉压(MAP),记录两组患者麻醉药物及血管活性药物用量、手术时间、术毕至拔管时间、出血量,随访术中知晓情况。结果两组患者在相同观察时间点的MAP比较差异无统计学意义(P>0.05),两组患者降压期间的心率比较,N组在T1(91.20±3.88)次/min和T2(88.80±4.20)次/min时的心率比C组在T1(79.87±5.18)次/min和T2(81.83±3.27)次/min显著增快(P<0.05),N组静安(200.00±16.19)mg和瑞芬太尼(490.33±31.57)μg用量少于C组静安(288.33±21.51)mg和瑞芬太尼(589.00±40.54)μg,硝酸甘油用量N组(6.90±1.00)mg明显多于C组(3.58±1.25)mg(P<0.05),N组术毕至拔管时间(28.43±3.12)min,较C组(43.03±4.18)min明显缩短,差异有统计学意义(P<0.05)。两组患者术后随访均无术中知晓发生。结论控制性降压鼻内镜手术中行Narcotrend麻醉深度监测可以降低麻醉药物的使用量,缩短患者术后复苏时间。

Objective To observe the effect of Narcotrend anesthesia depth monitoring on the recovery time of patients with induced hypotension nasal endoscopic operation. Methods 60 cases of patients with induced hypotension nasal endoscopic operation in our hospital whose ASA wasⅠ-Ⅱ in our hospital from February to June 2016 were selected,（ 18 years old to60 years old） and randomly divided into two groups, both groups adopted the induced hypotension, and the group N adjusted the anesthesia depth according to the NT value, and the NT level was maintained at D2-E1, the NT value was 46-20, and the group C controlled the anesthesia depth according to the experience, and the HR and MAP before anesthesia（T0）, at10 min in operation（T1）, at 30 min in operation（T2）, at the end of operation（T3） and at 10 min after tube drawing（T4）were recorded and the anesthesia drug dose, operation time, tube drawing time, bleeding amount and intraoperative awareness were compared. Results The difference in the MARP between the two groups was not statistically significant（P〈0.05）,and the heart rate in the group N at T1（91.20±3.88）times/min and T2（88.80±4.20）times/min was obviously accelerated compared with those in the group C at（79.87±5.18）times/min and T2（81.83±3.27）times/min（P〈0.05）, and the Jingan（20.0±16.19） mg and remifentanil（490.33±31.57） μg were less than that in the group C [（288.33±21.51）mg,（589.00±40.54）μg],and the glonoine dose in the group N was obviously more than that in the group C [（6.90±1.00）mg vs（3.58±1.25）mg]（P〈0.05）, and the tube drawing time in the group N was obviously shorter than that in the group C, [（28.43 ±3.12）min vs（43.03 ±4.18）min], and the difference was statistically significant（P〈0.05）. Conclusion The Narcotrend anesthesia depth monitoring in patients with induced hypotension nasal endoscopic operation can reduce the dose of anesthesia drugs and short the postoperative recovery time.