Narcotrend联合肌松闭环注射系统在全身麻醉中的应用

目的研究Narcotrend（NT）麻醉深度监测仪与闭环肌松注射系统（Close-Loop Muscle Relaxant Injection System，CLMRIS）联合应用于全身麻醉的临床效果及安全性。方法随机选择352例择期全身麻醉患者，ASAⅠ～Ⅱ级，随机分为4组：经验组（E组即对照组），NT组（N组），CLMRIS组（C组），NT与CLMRIS联合组（NC组），每组88例。E组依据麻醉医师临床经验判断实施麻醉；N组依据NT监测指导实施麻醉；C组依据CLMRIS指导肌松药使用；NC组联合使用NT及CLMRIS指导实施麻醉及肌松药使用。以入室（T0）、诱导即刻（T1）、插管（T2）、切皮（T3）、进腹（T4）、探查（T5）、关腹（T6）、缝皮（T7）、意识恢复（T8）、气管拨管（T9）、出室（T10）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）、NT分级（NTS）、NT指数（NTI）、肌松计数、TOF值、麻醉用药总量、插管时间（T2～T1）、苏醒时间、拔管时间、插管评级、出室时镇静评分，记录不良反应。结果4组患者术中生命体征均较平稳；NC组MAP、HR变化更为平稳（P〈0．05）；E组T8～T10各时点RR、SpO2较低（P〉0．05）。NC组NTS、NTI处于麻醉目标者较多（P〈0．05）；C、NC组肌松计数、TOF值于T3～T8时较低（P〈0．05），T9～T11，时较高（P〉0．05）。诱导期药量比较无统计学意义，差异主要产生于维持阶段。维持期NC组麻醉用药最小，E组最大（P〈0．05）；C组肌松及N组镇静镇痛药与NC组比较无统计学意义（P〉0．05）。NC组插管时间最长．苏醒时间、拔管时间最短、Copper评级、Ramsay评分最适宜（P〈0．05）。4组术中知晓无差异（P〉0．05），NC组无不良反应。结论NT麻醉深度监测仪与闭环肌松注射系统联合应用于全身麻醉，提高了全身麻醉的安全性。麻醉可控性强，诱导维持平稳，苏醒彻底及时，使用较少的麻醉药物达到最佳的麻醉效果，并可降低全身麻醉的不良反应。

Application of Narcotrend monitors combined with Close-Loop Muscle Relaxant Injection System in general anesthesia

Objective To research clinical efficacy and safety of Narcotrend monitors（NT） combined with Close-Loop Muscle Relaxant Injection System （CLMRIS） in general anesthesia. Methods 352 selected patients of general anesthesia, ASA Ⅰ - Ⅱ , were randomly divided into four groups： experience group （E group,n=88）, NT group （N group,n=88）, CLMRIS group （C group,n=88） and NT combined with CLMRIS group （NC group,n=88）. The anesthesiologist determined the delivery of anesthesia based on clinical experience in E Group, based on the guidance of anesthesia monitoring in N group, based on CLMRIS guidance of muscle relaxants used in C group, based on guidance of anesthesia and muscle relaxants used in NC group. Observed mean arterial pressure （MAP）, heart rate （HR）, respiratory rate （RR）, pulse oxygen saturation （SpO2）, NT stage （NTS）, NT index （NTI）, muscle relaxants count, train-of-four（TOF） value, the total narcotic medication, intubation time （T2-T1）, analepsia time, extubation time,intubation time,rating and sedation score out of room, rating and sedation score out of room at induced immediate, intubation,skin incision, into the abdomen, exploration, the abdomen closed, slit the skin, recovery of consciousness, tracheal tubes aside, out the operating room, respectively. Recorded adverse reaction. Results All patients vital signs were stable during surgery. MAP, HR changes of the NC group were more stable than that of others （P〈0.05）. RR and SpO2 were the lowest point in E Group of the T8-T10（P〉0.05）. NTS, NTI of NC group and N group were nearer to anesthesia target than that of the other two groups （P〈0.05）. Muscle relaxant count ,TOF value in NC group and C Group were lower than that of the other two groups （P〈0.05） in T3-T8, higher than that of the other two groups （P〈0.05） in the T9-T11. The dose of drugs in induction period was no significant differences, there were difference in the maintenance phase. In NC group, intubation time was the longest, recovery time and extubation time were the shortest, Copper rating and Ramsay score were the most appropriate （P〈0.05）. There were no differences of awareness in four groups （P〉0.05）,no adeverse reactions in NC group（P〈0.05）. Conclusion NT combined with CLMRIS in general anesthesia is useful to improve the safety. It＇s controllable, stable during induction, analepsia complete, achieving the best anesthetic effect by using less anesthetic agents and reducing the adverse ef- fects of general anesthesia.