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。

Application of Narcotrend-Assisted Anesthesia In-Depth Monitor During Total Intravenous Anesthesia in Children

Objective To explore the application of Narcotrend-assisted anesthesia in-depth monitor during total intravenous anesthesia in children.Methods From June to November 2013,a total of 40 children who underwent abdominal surgery were included in the study randomly.They were divided into Narcotrend group （n=20）and control group （n=20）.All patients received total intravenous anesthesia with propofol and remifentanil.The patients in Narcotrend group adj usted anesthesia in-depth according to Narcotrend index（NTI）.Those patients in control group adj usted anesthesia in-depth according to their heart rate（HR）,mean arterial pressure（MAP）and movement.Changes of hemodynamics,durations of emergence and tracheal extubation were recorded.The doses of propofol and remifentanil and the incidence rates of postoperative nasea and vomiting were also recorded.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Guangzhou Women and Children′s Medical Center. Informed consent was obtained from each participants′ parents. Results There were no significant differences in HR and MAP at 5 observation time points between two groups （P〉0.05 ）.The dose of propofol was lower in Narcotrend group than that of control group （122.71 ± 21.06 ） mg vs. （181.08±25.97）mg,P〈0.01].The durations of emergence and tracheal extubation were respectively shorter in Narcotrend group than those of control group （4.37±2.05）min vs.（9.15±5.13）min, （6.68±2.32）min vs.（12.45±5.15）min;P〈0.01].No one had postoperative nausea and vomiting in both groups.Conclusion Narcotrend-assisted anesthesia in-depth monitor can contribute to reduce the dose of propofol and shorten the duration of recovery during total intravenous anesthesia with propofol and remifentanil.