qCON、qNOX监测用于肝部分切除术麻醉管理的临床价值

Clinical value of qCON and qNOX monitoring for anesthesia in partial hepatectomy

目的:在肝部分切除术麻醉中监测qCON、qNOX和BIS(bispectral index,脑电双频指数),观察qCON和BIS间的相关性及qNOX用于监测伤害性刺激的价值。方法:择期行开腹肝部分切除术的患者40例,随机分为单纯全麻组(G组)和全身麻醉复合硬膜外阻滞组(GE组)。两组患者的麻醉均由具有10年以上临床经验的麻醉医师实施,实施者根据BIS监测数值调节麻醉镇静深度,且不知晓qCON和qNOX监测数值。给予qCON、qNOX、BIS和四个成串刺激(train-of-four stimulation,TOF)监测。常规麻醉诱导,行气管插管。术中停止异丙酚输注,调节七氟醚吸入浓度维持BIS值在40~60。术毕符合拔管指征后拔除气管导管,停止监测qCON、qNOX和BIS,并行VAS疼痛评分。所有患者均入苏醒室观察。术后24h随访有无术中知晓发生。结果:两组患者年龄、性别、体质指数(BMI)、ASA分级、手术时间、麻醉时间等一般资料比较差异无统计学意义。两组BIS、qCON、qNOX基础值、插管前即刻数值、术中平均水平、拔管前即刻数值比较差异均无统计学意义。GE组拔管后VAS评分均为0分,G组拔管后VAS评分0~3分,中位数为2分。qCON和BIS监测麻醉镇静深度相关(r^2=0.75)。结论:qCON和BIS用于监测术中麻醉镇静深度具有较好的相关性,qCON可用于麻醉镇静深度的监测;使用qNOX有助于监测全麻复合硬膜外阻滞及单纯全麻下肝部分切除术中的伤害性刺激。

Objective: To monitor the qCON, qNOX, and bispectral index (BIS) during anesthesia of partial hepatectomy, and investigate the correlation between qCON and BIS and the value of qNOX in monitoring noxious stimulation. Methods: Totally 40 patients undergoing semi-selective hepatectomy were randomly assigned into two groups, general anesthesia group (G group) and general anesthesia combined with epidural anesthesia group (GE group). Anesthesia in the two groups were performed by one anesthesiologist with more than 10 years of experience, who adjusted the level of hypnosis according to the continuous monitoring of BIS. The anesthesiologist was blinded for the values of qCON and qNOX. The measurements were obtained from a continuous recording of BIS, qNOX, qCON, and TOF. The value of BIS was kept at 40 to 60 with regulation of sevoflurane. After the surgery, when the indication was met, the extubation was performed, visual analogy scale (VAS) was evaluated and patients were sent to post anesthesia care unit (PACU). Patients were regularly assessed to determine whether awareness happened 24 h after surgery. Results: A total of 20 cases in G group and 20 cases in GE group completed the study. There were no significant statistical differences in age, gender composition, BMI, ASA classification, duration of surgery, and anesthesia between the two groups. There were no significant differences of BIS, qCON, qNOX in basic values, before intubation values, mean values during surgery, and after extubation values between the two groups. The mean VAS scores for the GE group were 0, and for the G group, the scores ranged from 0 to 3, the median value was 2. The correlation coefficient was 0.75 between BIS and qCON while analyzing with Spearman rank correlation. Conclusions: qCON might have a relatively good correlation with BIS and could be used to monitor the level of hypnosis during anesthesia. The use of qNOX might be helpful to monitor noxious stimulation during partial hepatectomy under general anesthesia combined with epidural block or general anesthesia alone.