NarcotrendTM麻醉深度指数监测在儿童口腔舒适化门诊全麻手术中的应用

Efficacy of Narcotrend index monitoring during general anesthesia in children undergoing dental operation in pediatric oral comfort clinic

目的观察NarcotrendTM麻醉深度指数(NTI)监测在儿童口腔舒适化门诊全麻中的应用效果。方法儿童口腔门诊全麻手术患者88例随机分为两组,每组44例。麻醉诱导采用静脉注射丙泊酚、芬太尼和维库溴铵,经鼻插管。麻醉维持:持续泵注丙泊酚5 mg·kg-1·h-1,依据NTI监测吸入七氟烷,维持NTI 45~55(A组)或NTI 56~65(B组)。记录术毕拔管时间、苏醒时间和离院时间(出院评分系统达到9分)。统计术中麻醉药物用量。结果两组均顺利完成手术,手术时间均在2 h左右。A组拔管时间、清醒时间和离院时间均长于B组(P<0.05或P<0.01)。两组术中丙泊酚用药量相仿,但A组七氟烷用量多于B组(P<0.01)。结论NTI监测能有效指导儿童口腔舒适化全麻门诊的麻醉用药;推荐NTI 56~65,术后苏醒早,恢复快。

Objective To observe the efficacy of Narcotrend index(NTI)monitoring during general anesthesia in pediatric oral comfort clinic.Methods Eighty-eight children aged 4-6 years old underwent dental operation in pediatric oral comfort clinic,who were randomly divided into 2 groups with 44 cases each.General anesthesia was induced with intravenous injection of propofol,fentanyl and vecuronium and nasotracheal intubation was performed.Anesthesia was maintained with an infusion of propofol 5 mg·kg-1·h-1 and sevoflurane inhalation to keep NTI 45-55 in group A or NTI 56-65 in group B.The extubation time,awakening time and the time to achieve a discharge score of PADSS 9 points were recorded.The intraoperative consumption of anesthetic drugs was calculated.Results The operation time was two hours or so and the surgery was successful in the two groups.The extubation time,awakening time and the time to achieve a discharge score of PADSS 9 points were all langer in group A than those in group B(P<0.05 or P<0.01).There was no significant difference in the consumption of propofol between the two groups,but the consumption of sevoflurane was significantly more in group A than that in group B(P<0.01).Conclusion NTI monitoring can effectively guide the use of anesthetic drugs in pediatric oral comfort clinic.NTI 45-55 is recommended for the children undergoing pediatric oral operation under general anesthesia,which has the advantages of early awakening and quick recovery.