单纯靶控输注不同浓度瑞芬太尼对Narcotrend脑电监测结果的影响

Effect of simple target-controlled infusion with different concentrations of remifentanil on result of Narcotrend electroencephalogram monitoring

目的观察单纯靶控输注不同浓度瑞芬太尼对麻醉/脑电意识监测系统(Narcotrend)的脑电监测分级及指数的影响。方法选择60例下肢手术患者,均行蛛网膜下腔麻醉,随机分为R2组、R4组、R6组、R8组各15例,依次对应输注2、4、6、8 ng/mL血浆靶控浓度瑞芬太尼。20 min后停止输注瑞芬太尼,记录Narcotrend指数(NI),并且呼唤患者1 min后再次记录NI值,记录此时患者清醒镇静评分(OAA/S)。结果靶控输注瑞芬太尼20 min后,R6组和R8组NI值分别为(46±14)和(44±16),与R2组和R4组比较显著下降(P <0. 05),OAA/S≤3分的患者也显著多于R2组和R4组(P <0. 05)。结论靶控输注瑞芬太尼<4 ng/mL时,不会影响NI值和OAA/S≤3分的患者比例,而输注6～8 ng/mL瑞芬太尼有镇静催眠作用,可降低NI值,OAA/S评分≤3分的患者例数显著增加。

Objective To investigate the effect of simple target-controlled infusion with different concentrations of remifentanil on grading and index of Narcotrend electroencephalogram monitoring. Methods Sixty patients with lower extremities surgery under subarachnoid anesthesia were randomized into group R2, group R4, group R6 and group R8, with the concentrations of 2, 4, 6 and 8 ng/mL remifentanil respectively. The Narcotrend index （NI） was recorded at 20 minutes after infusion of remifentanil and one minute for awakening patients, and the Observer′s assessment of alertness/sedation scale （OAA/S） was recorded as well. Results After target-controlled infusion of remifentanil for 20 minutes, the NIvalue was （46±14） and （44±16） in group R6 and R8 respectively, which were significantly lower than those in group R2 and R4 （ P 〈0.05）, the proportion of patients with OAA/S less than 3 points were significantly higher than group R2 and R4 （ P 〈0.05）. Conclusion Target-controlled infusion of remifentanil less than 4 ng/mL did not affect the NI value and the proportion of patients with OAA/S less than 3 points, while infusion of 6 to 8 ng/mL remifentanil has sedative and hypnotic effects, and it can reduce the NI value, increase the proportion of patients with OAA/S less than 3 points.