不同年龄患者意识消失时丙泊酚的用量

目的 观察患者麻醉诱导意识消失时丙泊酚用量及Narcotrend指数(NI)变化,探讨意识消失时年龄与丙泊酚用量和NI的相关性.方法 3～70岁择期手术患者140例,按年龄分为7组,3～10岁组(G1组)、11～20岁组(G2组)、21～30岁组(G3组)、31～40岁组(G4组)、41～50岁组(G5组)、51～60岁组(G6组)及61～70岁组(G7组),每组纳入BMI在正常范围内的男女患者各10例.静脉持续输注丙泊酚20 mg·kg-1·h-1至患者意识消失时停药,记录患者丙泊酚用量、意识消失时间及用药前后MAP、HR、NI的变化.结果 患者意识消失时G1组丙泊酚用量明显高于G2～G7组(P＜0.01),G2～G4组明显高于G6、G7组(P＜0.05).患者意识消失时丙泊酚用量与年龄呈显著负相关(r=-0.566,P＜0.001).意识消失时间随年龄的增长而缩短.与输注丙泊酚前比较,七组患者意识消失时MAP和NI均明显降低(P＜0.05).G1组NI明显高于G2～G6组(P＜0.05).年龄与NI无明显相关性(r=-0.082,P=0.289).结论 麻醉诱导意识消失时不同年龄患者丙泊酚用量和NI不同,年幼患者丙泊酚用量和NI高于其他年龄患者.     

Narcotrend在老年人喉罩全麻纤支镜检查中的应用

目的 观察Narcotrend在老年人喉罩全麻纤支镜检查中应用的可行性,寻求检查中最适宜的Narcotrend指数(narcotrend index,NTI). 方法 60例择期行喉罩全麻纤支镜检查的老年患者,采用随机数字表法分为3组(每组20例),其中Ⅰ组:NTI(79～65)组、Ⅱ组:NTI(64～37)组、Ⅲ组:NTI(＜37)组,监测各时间点的NTI、无创收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、平均动脉压(mean arterial pressure,MAP)、血氧饱和度(blood oxygen saturation,SpO2)、心率(heart rate,HR)和呼气末二氧化碳分压(end-tidal carbon dioxide partial pressure,PETCO2);记录置喉罩后达到靶NTI的时间及丙泊酚用量、苏醒时间、定向力恢复时间、副作用等. 结果 置喉罩后丙泊酚用量Ⅰ组(2.16±0.31) mg/kg、Ⅱ组(2.78-0.37) mg/kg、Ⅲ组(3.15±0.29)mg/kg,组间差异有统计学意义(P＜0.05).Ⅰ组进镜顺利率为85％,其余两组为100％.各组间SBP、DBP、MAP和HR差异有统计学意义(P＜0.05),且Ⅲ组有2例患者出现低血压及心动过缓.Ⅲ组苏醒时间及定向力恢复时间较Ⅰ组和Ⅱ组延长(P＜0.05). 结论 Narcotrend可监测老年患者麻醉镇静深度,指导调控丙泊酚用量,老年患者喉罩全麻纤支镜检查的适宜NTI为64～37.     

Narcotrend麻醉深度监测在小儿全身静脉麻醉中的应用

目的：探讨 Narcotrend 麻醉深度监测在小儿全身静脉麻醉中的临床效果。方法选择2013年6月~11月于广州市妇女儿童医疗中心住院治疗的40例择期腹部手术患儿为研究对象,按照入院序号,将其随机分为研究组（n=20）和对照组（n=20）。本研究遵循的程序符合广州市妇女儿童医疗中心人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与之签署临床研究知情同意书。两组患儿均接受丙泊酚-瑞芬太尼全身静脉麻醉,研究组患儿术中接受 Narcotrend麻醉深度监测,对照组患儿术中根据常规临床监测指标调节麻醉深度。监测两组患儿术前、麻醉诱导后、手术开始、手术结束、拔管5个时间点的心率（HR）、平均动脉压（MAP）。记录苏醒时间及拔管时间、丙泊酚和瑞芬太尼的用量及术后不良反应发生率。结果两组患儿5个时间点 H R和 MAP 的变化分别比较,差异均无统计学意义（P＞0.05）,而研究组患儿全身麻醉中丙泊酚用量、术后苏醒时间及拔管时间均显著小于对照组[（122.71±21.06）mg vs.（181.08±25.97）mg,（4.37±2.05）min vs.（9.15±5.13）min,（6.68±2.32）min vs.（12.45±5.15）min],并且差异有统计学意义（P＜0.01）。两组术后无一例患儿出现明显恶心、呕吐等不良反应,术后24 h随访结果显示,均无麻醉并发症发生。结论 Narcotrend 麻醉深度监测有助于减少静脉全身麻醉中丙泊酚用量,缩短患儿术后苏醒时间和拔管时间。     

Narcotrend用于全麻手术期间麻醉深度监测的临床评价

目的: 评价Narcotrend麻醉深度监测仪(NT)用于气管内静吸复合麻醉准确性及实用性.方法: ASA分级Ⅰ或Ⅱ级患者40例,随机均分为2组.观察组,以NT监测数据判断麻醉深度并调整用药;对照组,麻醉医师根据临床经验判断麻醉深度并调整用药.常规监测平均动脉压(MAP)、心电图(ECG)、心率(HR)等,计算用药总量,记录苏醒时间.结果: 观察组在切皮(T₄)、术中(T₅)、术毕(T₆)、出室(T₇)的MAP和HR与对照组比较差异有统计学意义(P<0.05～P<0.01),观察组在T₄、T₆、T₇的NT指数与对照组差异均有统计学意义(P<0.05～P<0.01),对照组在T₆、T₇的NT指数与基础值(T₁)差异均有统计学意义(P<0.01和P<0.05);2组患者丙泊酚、舒芬太尼和七氟烷用量差异均有统计学意义(P<0.01),咪达唑仑用量差异无统计学意义(P>0.05);观察组的苏醒时间和拔管时间均短于对照组(P<0.05);观察组无一例发生术中知晓,对照组有1例发生术中知晓.结论: NT能较好地反映全麻手术患者镇静深度变化,有助于判断全麻深度,指导个体化麻醉用药,提高麻醉质量.     

Narcotrend监测在七氟醚-舒芬太尼腹部手术麻醉苏醒期的应用

目的 观察Narcotrcnd(NT)麻醉深度监测和常规的血流动力学指标(平均动脉压、心率)对腹部手术患者七氟醚-舒芬太尼麻醉苏醒期意识恢复的预测作用.方法 随机选择40例ASA Ⅰ～Ⅱ级择期行腹部手术患者,分为NT监测组和常规监测组(对照组).以吸人七氟醚、靶控舒芬太尼进行麻醉诱导和维持.术中调整七氟醚和舒芬太尼浓度分别维持NT为D1-D2级或平均动脉压(MAP)、心率(HR)在(基线水平±20%)范围内波动.记录麻醉苏醒期间对刺激无反应、呼之睁眼、定向力恢复时NT分级(NTS)和NT指数(NTI)、MAP、HR,计算上述参数对应意识变化不同阶段的预测概率值(Pk).结果 NTS、NTI预测对刺激无反应-呼之睁眼的Pκ分别为0.95、0.92,预测对刺激无反应一定向力恢复的Pκ分别为0.92、0.89,预测呼之睁眼.定向力恢复的Pκ分别为0.91、0.88,显著高于O.5(P<0.05),也高于MAP、HR的相应预测值(P<0.05).与常规监测组比较,NT监测组的苏醒时间明显缩短(P<0.05),舒芬太尼用量明显减少.结论 NI监测能预测腹部手术患者麻醉苏醒期意识水平的变化,预测能力显著高于常规的血流动力学指标;NT监测能减少七氟醚-舒芬太尼麻醉剂的用量、缩短麻醉苏醒时间.     

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。     

Comparison of Narcotrend Index,Bispectral Index,spectral and entropy parameters during induction of propofol-remifentanil anaesthesia

Objective This study investigated the suitability of various electroencephalogram (EEG) parameters to describe anaesthetic drug effects in propofol-remifentanil anaesthesia. The investigated parameters were the Narcotrend^? Index (NI), the Bispectral Index^TM (BIS^TM), and standard spectral and entropy parameters. Additionally, it was investigated whether the effect of a fixed dosage of propofol on the attained depth of hypnosis during induction of anaesthesia is different in male and female patients. Methods Standardized inductions of anaesthesia in 10 male and 10 female patients (ASA status I or II, 15–75 years) were analysed. All patients received 4 mg propofol/kg over 6 min followed by 4 mg/kg/h. For analgesia, patients received 0.3 μg/kg/min remifentanil starting 2 min before propofol application. For EEG monitoring, the Narcotrend and the Aspect A-2000 Bispectral Index monitor were used simultaneously. Data from start of propofol injection until 1 min after the end of the induction period (420 s) were used for statistical analysis. EEG parameters were evaluated every 10 s. Results The Narcotrend^? Index and the Bispectral Index^TM had the highest mean correlations with the calculated propofol effect-site concentration and were able to distinguish stages from the awake state or the near awake state and stages of deep hypnosis. On the Narcotrend scale, more data points are available for levels of anaesthesia with relevance for maintenance of anaesthesia. The BIS values at the first occurrence of burst suppression were significantly higher than the corresponding NI values. During induction of anaesthesia, the same dosages of propofol (per kg body weight) given to men and women did not show different effects on the EEG. Conclusions NI and BIS are superior to␣spectral and entropy parameters in describing changes of propofol concentration during induction of propofol-remifentanil anaesthesia. Drs. U. Grouven, A. Schultz and B. Schultz are members of the research group that developed the classification algorithms implemented in the EEG monitor Narcotrend. Schultz A, Siedenberg M, Grouven U, Kneif T, Schultz B. Comparison of Narcotrend Index, Bispectral Index, spectral and entropy parameters during induction of propofol-remifentanil anaesthesia.     

Failure of Two Commercial Indexes and Spectral Parameters to Reflect the Pharmacodynamic Effect of Desflurane on EEG

Objective We compared two PK/PD models, one with and one without a plateau effect. Bispectral (BIS, Aspect Medical Systems, Natick, MA, version XP) and Narcotrend™ (NCT, MonitorTechnik, Bad Bramstedt, Germany, Version 4.0) indices were used as an electroencephalographic measure of desflurane drug effect. Methods With IRB approval and informed consent we investigated 20 adult patients scheduled for radical prostatectomy. At least 45 minutes after induction of general anaesthesia, end-tidal concentrations of desflurane was varied between 3 and 10 vol%. To evaluate the relationship between concentrations and EEG indices, two different pharmacodynamic models were applied: A conventional model based on a single sigmoidal curve, and a novel model based on two sigmoidal curves for BIS and NCT values with and without burst suppression. The parameters of the models␣were estimated by NONMEM V (GloboMax, Hanover, USA) by minimizing log likelihood. Statistical significance between the two models was calculated by the likelihood ratio test. Results The maximum end-tidal desflurane concentration during the two concentrations ramps was 10.0 ± 1.4 vol%. The mean BIS and NCT values decreased significantly but slightly with increasing end-tidal desflurane concentrations between 4 and 8 vol%. Therefore a two sigmoidal curves PK/PD model including a plateau describes the effects of desflurane on BIS and Narcotrend better than a single sigmoidal curve model. The difference between the log likelihood values of the new PK/PD model with two connected sigmoidal curves and the classical E _max model with one sigmoidal curve is 634 (P < 0.001) for the BIS monitor and 4089 (P < 0.001) for the NCT. Conclusions BIS and Narcotrend are not useful to differentiate pharmacodynamic changes in the EEG between 4 and 9 vol% desflurane. This study was presented in part at the American Society of Anesthesiologists meeting October 20, 2005 Atlanta. Kreuer S, Bruhn J, Ellerkmann R, Ziegeler S, Kubulus D, Wilhelm W. Failure of two commercial indexes and spectral parameters to reflect the pharmacodynamic effect of desflurane on EEG.     

Narcotrend~脑电监测系统用于癫痫患者麻醉深度评价的临床研究

目的观察Naroctrend(脑电监测在癫痫患者麻醉诱导期的使用价值,比较癫痫与非癫痫患者对丙泊酚的敏感性。方法癫痫组(E组)为19例长期服用抗癫痫药物择期行颞叶切除术的癫痫患者,非癫痫组(NE组)为24例择期行开颅手术的非癫痫患者,麻醉诱导采用靶控输注丙泊酚,用警觉/镇静评分标准(OAA/S)评估诱导期间患者的意识变化,记录并比较意识消失、气管插管和切皮等不同时间点的Narcotrend脑电指数(NTI)、血压(BP)、心率(HR)及丙泊酚效应室靶浓度(Ce)。结果在意识消失阶段(OAA/S评分=1、2),E组患者的Ce值比NE组小(P<0.05)。随着OAA/S评分的降低,E组的Ce值上升幅度较缓,但其NTI却表现出比NE组更快的下降速度。两组患者的Ce、NTI与OAA/S评分均显著相关(P<0.01)。麻醉诱导期,随着Ce的增加,两组患者NTI、BP和HR均有显著降低(P<0.05),但两组之间NTI未见明显差异。结论癫痫患者在麻醉诱导阶段对丙泊酚的敏感性较高。Narcotrend(脑电监测系统可以用于癫痫患者诱导及维持阶段的麻醉深度监测。