Narcotrend联合Most Care监测下平稳麻醉方法的研究

Hemodynamic changes during anesthesia induction with sevoflurane inhalation or target controlled infusion of propofol monitored by mostcare

目的:探讨Narcotrend指数(NI)指导七氟烷吸入麻醉与靶控输注(TCI)丙泊酚和瑞芬太尼麻醉诱导至气腹后5 min的血流动力学对比,提供一种能够保证足够的麻醉深度及平稳的麻醉方法。方法:择期手术患者60例行腹腔镜手术患者,按随机数字表法分为两组:丙泊酚联合瑞芬太尼TCI组(TCI组,n=30)和全凭吸入麻醉组(七氟烷组,n=30)比较两组分别在入室时(T_(1))、NI=40时(T_(2))、插管后5 min(T_(3))、气腹开始5 min后(T_(4))时段的心率(HR)、平均动脉压(MAP)、每搏变异度(PVV)、周围血管阻力指数(SVRI)、心输出量(CO)、每搏量(SV)。结果:在T_(2)时,七氟烷组HR高于TCI组,MAP、SVRI低于TCI组,且均低于T_(1)时,差异有统计学意义(P<0.05);在T_(4)时,七氟烷组的MAP、SVRI低于TCI组,差异有统计学意义(P<0.05);T_(3)时,七氟烷组NI值低于TCI组,差异有统计学意义(P<0.05)。结论:在Narcotrend监测仪和MostCare血流动力学监测下,靶控输注丙泊酚及瑞芬太尼比吸入七氟烷麻醉更能使患者的MAP、HR、SV、PVV等血流动力学指标趋于平稳,减少低血压的发生。

Objective To explore the comparison of hemodynamics between target controlled infusion of propofol with remifentanil and total inhalation anesthesia under the guidance of Narcotrend combined with mostcare in gynecological patients,so as to provide a more stable anesthesia method.Method Sixty patients scheduled for laparoscopic surgery were randomly divided into two groups:propofol and remifentanil TCI group(TCI group,n=30)and all inhalation anesthesia group(sevoflurane group,n=30).The HR,MAP,PVV,SVRI,CO and SV of the two groups were compared at the time of entering the room(T_(1)),Narcotrend value=40(T_(2)),5 min after intubation(T_(3))and 5 min after pneumoperitoneum(T_(4)).Results At T_(2),HR in sevofluran group was higher the that in TCI group,MAP and SVRI were lower than that in TCI group,and both were lower than T_(1),the difference was statistically significant(P<0.05);at T_(4),MAP and SVRI in sevoflutan group were lower than those in TCI grop,and the difference was statistically signifcant(P<0.05);at T_(3) the NI value of the sevofluran group was lower than that of TCI group,and the difference was statistically signficant(P<0.05).Conclusion Under the monitoring of Narcotrend monitor and mostcare hemodynamics,target controlled infusion of propofol and remifentanil can make MAP,HR,SV,PVV and other hemodynamic indexes more stable and reduce the occurrence of hypotension than sevoflurane inhalation anesthesia.