Narcotrend脑电监测用于颅内动脉瘤夹闭术病人全麻诱导期的临床观察

Clinical observation of Narcotrend monitoring during general anesthesia induction period in patients undergoing intracranial aneurysm clipping operation

目的评估Narcotrend监测指导下丙泊酚靶控输注(TCI)对颅内动脉瘤病人全麻诱导期应激反应和血流动力学的影响。方法 40例择期颅内动脉瘤夹闭术病人,随机分为观察组(N组)和对照组(C组),N组以NTI维持在37-46为目标,调节丙泊酚效应室浓度完成诱导;C组以体质量为依据,人工静脉推注丙泊酚完成诱导。分别在诱导前(T0)、气管插管前(T1)、气管插管后1 min(T2)和气管插管后3 min(T3)记录2组病人的平均动脉压(MAP)和心率(HR)。同时采血测定血浆肾上腺素和促肾上腺皮质激素的水平。结果与诱导前比较,2组病人MAP和HR均有下降,气管插管后MAP和HR均有升高,与C组相比,N组病人MAP和HR波动更小,二者的差异有统计学意义(P<0.05)。N组病人插管后血浆肾上腺素和促肾上腺皮质激素水平升高,但C组升高更为显著,差异有统计学意义(P<0.05)。结论 Narcotrend脑电监测指导下行个体化丙泊酚靶控输注诱导能有效抑制应激反应,血流动力学更加平稳,明显优于常规人工推注诱导。

Objective To evaluate the effects of target-controlled infusion of propofol guided by Narcotrend monitoring on stress reactions and hemodynamics in patients undergoing intracranial aneurysm surgery.Methods Forty consecutive patients with intracranial aneurysmal surgery under general anesthesia were divided into group N and group C randomly.Group N was induced using TCI system with propofol under the moniting of Narcotrend and the infusion speed of propofol was adjusted to maintain the Narcotrend index to level 37-46,Group C was regulated by anesthesia manually based on body weight and clinical signs.MAP,HR were recorded and blood samples were taken for the measurements of plasma epinephrine(E),ACTH before induction(T0),before tracheal intubation(T1),and 1(T2),3(T3)minutes afterwards.Results Compared with before induction,MAP and HR had significant change in Group C than in Group N(P<0.05).Plasma epinephrine(E),ACTH increased significantly in Group C than in Group N after tracheal intubation(P<0.05).Conclusion The application of Narcotrend monitor to TCI of propofol can relieve stress reactions and reduce hemodynamic responses,and be superior to traditional induction methods.