Narcotrend麻醉深度监测仪在全凭静脉麻醉中的应用

目的研究Narcotrend（NT）麻醉深度监测仪用于全凭静脉麻醉的临床效果及安全性。方法随机选择择期全身麻醉患者208例,ASAⅠ-Ⅱ级,随机分为两组：NT麻醉深度监测组（N组）、经验给药组（E组）,每组104例。N组采用NT麻醉深度监测给予麻醉药,E组采用麻醉医师临床经验判断给予。分别于入室、诱导即刻、插管、切皮、进腹、探查、关腹、缝皮、意识恢复、气管拔管、出室等11个时间点,观察记录平均动脉压（MAP）、心率（HR）、呼吸频率（RR）、脉搏氧饱和度（SpO2）;记录NT分级（NTS）、NT指数（NTI）;记录镇静药总量、肌松药总量、苏醒时间、拔管时间及术中知晓率。应用SPSS 12.0软件,组间计量资料比较用t检验,计数资料用χ2检验,P〈0.05为差异有统计学意义。结果两组患者术前术中生命体征均比较平稳;N组较E组MAP、HR变化更为平稳（P〈0.05）,RR、SpO2无明显变化。N组较E组咪达唑仑、丙泊酚、瑞芬太尼及多沙普用量均减少（P〈0.05）,芬太尼用量无明显变化;苏醒时间、拔管时间及术中知晓率均降低（P〈0.05）。结论本研究表明,NT麻醉深度监测仪用于全凭静脉麻醉有利于控制麻醉深度,使用较少的麻醉药物达到最佳的麻醉效果,缩短复苏过程,且能避免术中知晓等不良后果。

Application of Narcotrend monitor in total intravenous anesthesia

Objective To explore the clinical effects and safety of Narcotrend monitor（NT） in total intravenous anesthesia.Methods Two hundred and eight patients（ASA grade Ⅰ-Ⅱ） undergoing selective general anesthesia were randomly divided into observation group and control group（n=104 for each group）.The NT was used in observation group but not in the control group to monitor the anesthesia depth of patients.The mean arterial pressure（MAP）,heart rate（HR）,respiratory rate（RR）,pulse oxygen saturation（SpO2）,NT stages（NTS） and NT index（NTI） were determined on the time points of entering the operation room,anesthetic induction,intubation,skin incision,entering the abdomen,abdominal exploration,closing the abdomen,sewing skin,awareness recovery,post-anesthesia tracheal extubation,and going out the operation room.The total doses of sedatives and muscle relaxant,the recovery time,the extubation time and the incidence rate of intraoperative awareness were recorded.Results The vital signs were stable in patients of both groups.The MAP and HR were more stable in observation group than those in control group（P〈0.05）.The doses of midazolam,propofol,remifentanil and doxapram used in patients of observation group were significantly fewer than those in control group.Compared with those of control group,the recovery time,the extubation time and the incidence rate of intraoperative awareness were significantly decreased in the observation group（P〈0.05）.Conclusion With NT,the doctor can use fewer sedatives and get the best anesthesia effects,shorter recovery time and reduce the incidence of intraoperative awareness.