丙泊酚联合瑞芬太尼调控Narcotrend监测在介入手术中的临床研究

Clinical study of propofol combined with remifentanil regulating narcotrend monitoring in interventional surgery

目的:探讨丙泊酚联合瑞芬太尼调控Narcotrend监测仪在介入手术中麻醉深度的临床效果。方法:将全身麻醉状态下需行介入手术的150例患者根据随机数字表法分成对照组(Con组)、浅麻醉A组(NLA组)和深麻醉A组(NDA组)、浅麻醉B组(NLB组)和深麻醉B组(NDB组)。于T1、T2、T3、T4、T5、T6、T7、T8时间点记录Sp O2、MAP、DBP、SBP、HR及T1、T5、T6、T7、T8时间点血清TNF-α、IL-1β水平。结果:NLB、NDB组患者丙泊酚用量、瑞芬太尼用量小于NLA、NDA组患者(P<0.05)。ELISA法测血清TNF-α、IL-1β水平在T6、T7、T8时间点差异具有统计学意义(P<0.05),在T1、T5时间点差异无统计学意义(P>0.05)。流式细胞分析白细胞凋亡在T1、T5、T6、T7、T8时间点差异有统计学意义(P<0.05)。苏醒时间t1、t2、t3差异具有统计学意义(P<0.05)。NLA、B组和NDA、B组在T6、T7、T8的NTI差异具有统计学意义(P<0.05)。结论:Narcotrend监测应用于介入手术麻醉中,可有效减少瑞芬太尼和丙泊酚的用量,更精确地控制麻醉深度,减少血流动力学的波动及苏醒的时间,并降低患者术后血清炎性因子的水平。

Objective:To discuss the clinical effect of propofol in combination with remifentanil Narcotrend monitors on the depth of anesthesia in interventional surgery.Method:150 patients requiring interventional surgery under general anesthesia were divided into control group(Con group),group A under shallow anesthesia(NLA group),group A under deep anesthesia(NDA group),group B under shallow anesthesia(NLB group)and group B under deep anesthesia(NDB group)according to random number table.SpO2,MAP and DBP were recorded at time points T1,T2,T3,T4,T5,T6,T7 and T8,SBP,HR and serum TNF-αand IL-1βlevels at T1,T5,T6,T7 and T8 time points.Result:The dosage of propofol and remifentanil in NLB and NDB groups were lower than those in NLA and NDA groups(P<0.05):The levels of TNF-αand IL-1βin serum were measured by ELISA at T6,T7 and T8 time points(P<0.05),but there was no significant difference at T1 and T5 time points(P≥0.05).Flow cytometry showed significant difference in apoptosis at T1,T5,T6,T7 and T8 time points(P<0.05).The difference of recovery time tl,t2 and t3 was statisticaily significant(P<0.05).The difference of NTI in T6,T7 and T8 between group NLA and B and group NDA and B was statistically significant(P<0.05).Conclusion Narcotrend monitoring could effectively reduce the dosage of remifentanil and propofol in interventional anesthesia,control the depth of anesthesia more accurately,reduce hemodynamic fluctuation and recovery time,and reduce the level of serum inflammatory factors after surgery.Conclusion:Narcotrend monitoring for interventional anesthesia could effectively reduce the amount of remifentanil and propofol,control the depth of anesthesia more accurately,reduce hemodynamic fluctuation and recovery time,and reduce the level of serum inflammatory factors after surgery.