Narcotrend监测七氟烷复合不同静脉药时麻醉深度变化的临床研究

目的 观察临床浓度七氟烷复合阿片受体激动剂或β1受体阻滞剂在麻醉维持期Narcotrend参数和血流动力学指标,评价术中麻醉深度.方法 择期胃、肠手术的病人60例,随机均分为七氟烷组(S 组)、七氟烷复合瑞芬太尼组(SR 组)和七氟烷复合艾司洛尔组(SE 组).调整不同组中七氟烷的吸入浓度,达到控制术中血压在基础值±20%,心率在60～100次/min的目标.观察3组血流动力学、NT值、血糖、平均MAC值.术后随访患者是否存在术中知晓.结果 术中血流动力学平稳,S组和SE组的NT值维持在61～35之间(P ＞0.05),SR组的NT值在65～40之间,高于S组和SE组(P ＜0.05).S组平均MAC值最高,SR组最低,差异有统计学意义(P ＜0.05).3组停药时血糖均比基础值升高(P ＜0.05).手术后随访,SR组有1例病人可疑术中知晓.结论 Narcotrend 可以监测七氟烷麻醉维持期间的麻醉深度,NT值＜64,NT分级在D0以下,患者无术中知晓;瑞芬太尼或艾司洛尔可以减少七氟烷麻醉的MAC值.

Clinical Observation of the Depth of General Anesthesia of Sevoflurane Combined Different Intravenous Anesthetics under the Monitoring of Narcotrend

Objective To observe Narcotrend(NT) parameters and hemodynamic parameters during anesthesia maintenance period with clinical commonly used concentration of sevoflurane,and sevoflurane combined the opioid receptor agonist or β1 blockers,and to evaluate the depth of general snesthesia.Methods Sixty patients undergoing selective gastrointestinal surgery were randomly divided into three groups: sevoflurane inhalation anesthesia(group S),sevoflurane combined with remifentanil anesthesia(group SR)and sevoflurane anesthesia combined esmolol(group SE).During the anesthesia maintenance period,by adjusting the concentration of sevoflurane inhalation within different groups in order to achieve the target of maintaining MAP of intraoperative in the basic values of ± 20% and HR of 60 ~ 100 times/min.Then we observed the hemodynamic parameters,NT values,blood glucose and the mean value of MAC in three groups.The patients were followed up after surgery to learn whether there was intraoperative awareness.Results There were stable hemodynamics in anesthesia maintenance phase.NT values of group S and group SE were maintained between 61 and 35(P>0.05).NT values of group SR was between 65 and 40,higher than the group S and the group SE(P<0.05).In this phase,group S had the maximum of sevoflurane MAC values,group SR had the lowest,the two groups were compared with the group SE,and the difference was statistically significant(P<0.05).The blood glucose levels at withdrawal time point were higher than baseline in three groups(P<0.05).According to the results of post-operative follow-up,there was one patient with suspected intraoperative awareness in group SR.Conclusion Narcotrend can monitor the depth of anesthesia during the maintenance of sevoflurane anesthesia,there is no intraoperative awareness during sevoflurane anesthesia when NT values is less than 61 and NT classification is under D0.Remifentanil or esmolol can decrease minimum alveolar concentration of sevoflurane during the maintenance of operation under general anesthesia.