Narcotrend监测下右美托咪定在单肺通气患者中的应用效果

Efficacy of dexmedetomidine with Narcotrend monitoring applied to patients undergoing one-lung ventilation

目的探讨Narcotrend监测下右美托咪定在单肺通气患者中的应用效果。方法选择胸腔镜下行肺叶(肺段)切除手术的患者40例,随机分为对照组和右美托咪定组,每组20例。右美托咪定组、对照组于麻醉诱导时分别开始持续输注右美托咪啶、生理盐水至单肺通气结束。术中使用Narcotrend监测麻醉深度,局部脑氧饱和度(rSO_2)监测仪监测rSO_2变化。记录两组诱导前(T0)、插管即刻(T_1)、手术切皮(T_2)、单肺通气30 min(T_3)、单肺通气60 min(T_4)、单肺通气90 min(T_5)、手术结束(T6)时的平均动脉压(MAP)、心率(HR)及左右侧rSO_2值;比较两组苏醒所需时间、苏醒期镇静躁动评分(SAS)、麻醉维持期丙泊酚及瑞芬太尼用量。结果两组MAP、HR及右侧rSO_2在各时间点比较,差异均无统计学意义(P>0.05),但右美托咪定组的左侧rSO_2在各时间点高于对照组(P<0.05)。对照组T_1、T_2、T_5的MAP低于T0,右美托咪定组T_2、T_5的MAP低于T0(P<0.05);对照组T_4的HR低于T0,右美托咪定组T_2~T6的HR均低于T0(P<0.05);两组组内T_1~T_4、T6时点的左右侧rSO_2均高于T0(P<0.05)。MAP、HR和右侧rSO_2的分组与时间均无交互效应(P>0.05)。与对照组比较,右美托咪啶组维持麻醉期丙泊酚用量减少,SAS评分降低(P<0.05),但两组维持麻醉期瑞芬太尼用量及苏醒所需时间比较,差异无统计学意义(P>0.05)。结论在Narcotrend监测下右美托咪定对单肺通气患者的MAP、HR和右侧rSO_2的波动变化无明显影响,但可改善左侧rSO_2,并明显减少麻醉需求量以及苏醒期躁动的发生。

Objective To investigate the efficacy of dexmedetomidine with Narcotrend monitoring applied to patients undergoing one-lung ventilation. Methods Forty patients undergoing thoracoscopic lobectomy/segmentectomy were randomly divided into control group and dexmedetomidine group,with 20 cases in each group. During the anesthesia induction,the dexmedetomidine group and the control group received the continuous infusion of dexmedetomidine and normal saline,respectively,until the end of one-lung ventilation. The depth of anesthesia was monitored by Narcotrend system in the operation,and the changes in regional cerebral oxygen saturation（ rSO2） were monitored by rSO2 monitor. Before induction（ T0）,immediately after intubation（ T1）,at the moment of skin incision（ T2）,at 30（ T3）,60（ T4） and 90 minutes of one-lung ventilation（ T5）,and at the end of surgery（ T6）,mean arterial pressure（ MAP）,heart rate（ HR）,and the left and right rSO2 values were recorded in the two groups. The time for recovery,Sedation-Agitation Scale（ SAS） score,and the amount of propofol or remifentanil during anesthesia maintenance period were compared between the two groups. Results No significant differences were observed in MAP,HR or right rSO2 value between the two groups at each time point（ P〈0.05）,however,the left rSO2 value in the dexmedetomidine group was higher than that in the control group at each time point（ P〈0.05）,MAP at T1,T2 or T5 was lower than that at T0 in the control group,and MAP at T2 or T5 was lower than that at T0 in the dexmedetomidine group（ P〈0.05）; HR at T4 was lower than that at T0 in the control group,and HR at T2-T6 was lower than that at T0 in the dexmedetomidine group（ P〈0.05）; the left and right rSO2 values at T1-T4 and T6 were higher than those at T0 in both groups（ P〈0.05）. MAP,HR or right rSO2 value showed no interaction effects between group and time. Compared with the control group,the dexmedetomidine group had less amount of propofol and lower SAS score during anesthesia maintenance period（ P〈0.05）,but there was no significant difference in the amount of remifentanil or time for recovery between the two groups（ P〈0.05）.Conclusion With Narcotrend monitoring,dexmedetomidine has no significant effect on the fluctuation changes in MAP,HR or rSO2 in patients undergoing one-lung ventilation,but can significantly reduce the demand for anesthesia as well as the incidence of restlessness during recovery period.