Narcotrend联合TCI非插管全麻在胸腔镜下交感神经切断术中的应用

Application of Narcotrend combined with TCI non-intubated general anesthesia in thoracoscopic sympathectomy

目的探究麻醉/脑电意识深度监测系统(Narcotrend)联合靶控输注(TCI)非插管全身麻醉(全麻)在胸腔镜下交感神经切断术中的应用。方法160例行胸腔镜下交感神经切断术的手汗症患者,按照抽签法分为对照组和观察组,每组80例。对照组采用喉罩插管丙泊酚(1%)全静脉麻醉,观察组采用Narcotrend联合TCI非插管全麻。比较两组复苏期躁动情况、麻醉前后血流动力学指标、不良反应发生率以及临床指标。结果观察组复苏期躁动率2.50%明显低于对照组的11.25%,差异具有统计学意义(P<0.05)。麻醉后,对照组心输出量(CO)、外周血管阻力(SVR)、每搏输出量(SV)均低于麻醉前,观察组CO、SVR低于麻醉前,差异具有统计学意义(P<0.05);观察组麻醉前后SV对比差异无统计学意义(P>0.05)。麻醉后,两组CO、SVR指标对比,差异无统计学意义(P>0.05);观察组的SV(69.01±1.12)ml高于对照组的(67.60±0.95)%,差异具有统计学意义(P<0.05)。观察组不良反应发生率10.00%低于对照组的13.75%,但差异无统计学意义(P>0.05)。两组意识消失时间比较差异无统计学意义(P>0.05);观察组的苏醒时间(14.05±3.23)min短于对照组的(17.74±3.08)min,麻醉药物用量(0.23±0.04)mg/(kg·min)少于对照组的(0.26±0.08)mg/(kg·min),差异具有统计学意义(P<0.05)。结论在胸腔镜下交感神经切断术中采用Narcotrend联合TCI非插管全麻,患者在复苏期的躁动率较低,麻醉药物用量较少,麻醉效果良好,且麻醉期间的血流动力学指标波动较小,麻醉不良反应发生率低,具有安全性。

Objective To investigate the application of Narcotrend combined with target controlled infusion(TCI)non-intubated general anesthesia in thoracoscopic sympathectomy.Methods A total of 160 hyperhidrosis patients undergoing thoracoscopic sympathectomy were divided into control group and observation group,with 80 cases in each group.The control group received laryngeal mask intubation with propofol(1%)for general intravenous anesthesia,and the observation group received Narcotrend combined with TCI nonintubated general anesthesia.The restlessness during resuscitation,hemodynamic parameters before and after anesthesia,occurrence of adverse reactions and corresponding clinical indicators were compared between the two groups.Results The restlessness rate during resuscitation 2.50%of the observation group was obviously lower than that of the control group 11.25%,and the difference was statistically significant(P<0.05).After anesthesia,cardiac output(CO),systemic vascular resistance(SVR),stroke volume(SV)of the control group was lower than that before anesthesia,and CO and SVR of the observation group was lower than that before anesthesia,and the difference was statistically significant(P<0.05).There was no statistically significant difference in SV before and after anesthesia(P>0.05).After anesthesia,there was no statistically significant difference in CO and SVR between the two groups(P>0.05);SV(69.01±1.12)ml of the observation group was higher than that of the control group(67.60±0.95)ml,and the difference was statistically significant(P<0.05).The incidence of adverse reactions 10.00%of the observation group was lower than that of the control group 13.75%,but the difference was not statistically significant(P>0.05).There was no statistically significant difference in consciousness disappearance time between the two groups(P>0.05).The wake-up time(14.05±3.23)min of the observation group was shorter than that of the control group(17.74±3.08)min,and anesthetic dosage(0.23±0.04)mg/(kg·min)was less than that of the control group(0.26±0.08)mg/(kg·min),and the difference was statistically significant(P<0.05).Conclusion Narcotrend combined with TCI non-intubated general anesthesia shows good anesthesia effect in thoracoscopic sympathectomy,which has the advantages of lower restlessness rate during the resuscitation,small amount of anesthetic drugs,the anesthesia effect is good,and small hemodynamic index fluctuation during anesthesia,low incidence of adverse reactions to anesthesia and high safety.