Narcotrend 在硬膜外复合全身麻醉患者苏醒期意识恢复预测的评价

目的：观察Narcotrend麻醉深度监护仪对硬膜外复合七氟烷吸入麻醉患者苏醒期意识恢复的预测效果。方法40例ASAⅠ～Ⅱ级在硬膜外复合全身麻醉下择期行肠道手术患者，丙泊酚复合苏芬太尼靶控输注诱导，手术期间通过硬膜外镇痛、七氟烷镇静、顺式阿曲库铵肌肉松弛来维持麻醉。手术结束入麻醉恢复室，记录刺激无体动反应（ T1）、呼之睁眼（T2）、定向力恢复（T3）时Narcotrend指数（Narcotrend Index，NI）、七氟烷最低肺泡有效浓度（MAC）、平均动脉压（MAP）和心率（HR），通过相关参数计算出上述参数对意识恢复的预测概率（PK）。结果硬膜外复合全身麻醉监测NI值能够预测苏醒期患者意识的改变。 NI预测患者呼之睁眼时PK 值为（0．76±0．07），预测定向力恢复时PK 值为（0．74±0．06），高于0．5（P＜0.05），也高于MAP和HR的相应得预测概率PK 值。苏醒期NI值与七氟烷MAC值的变化呈明显的负相关性，相关系数（r）为－0．896（P＜0．01）。结论 Narcotrend能有效地反映硬膜外复合全身麻醉下苏醒期患者意识水平的变化，其对苏醒期意识恢复的预测能力显著高于血流动力学指标。

The predictive effect of Narcotrend monitor on consciousness recovery during emergence of general anes-thesia combined with epidural block

Objective To evaluate the predictive effect of Narcotrend on consciousness recovery during the emergence of gen -eral anesthesia combined with epidural block .Methods Forty ASAⅠorⅡpatients undergoing elective bowel surgery were anesthe-tized with general anesthesia combined with epidural block .Anesthesia was induced by target controlled infusion of propofol combined with sufentanil,and maintained by epidural analgesia ,sevoflurane in sedation and cisatracurium in muscle relaxant .After surgery,the patients were transferred to the postanesthesia care unit （PACU）,the values of NI （Narcotrend Index）,minimum alveolar concentration （ MAC） of sevoflurane ,and hemodynamic parameters （ MAP and HR） were recorded during the period of non-reaction to the stimulation （T1）,at the time of eyes opening （T2） and orientation recovery （T3）.The prediction probability （PK） of each parameter was calculat-ed.Results NI were correlated well with the changes of consciousness during the emergence of general anesthesia combined with epi -dural block.PK values of NI in predicting eyes opening and orientation recovery were （0.76±0.07）,（0.74 ±0.06）,respectively,and were obviously higher than 0.5 and the PK values of MAP and HR （P〈0.01）.The values of NI were obvious negative correlated with MAC values of sevoflurane,and correlation coefficient was -0.896 （P〈0.01）.Conclusion Narcotrend monitor can be effectively used for predicting patients＇consciousness recovery during the emergence of general anesthesia combined with epidural block ,however, the ability of prediction with Narcotrend on consciousness recovery was significantly higher than that of hemodynamic parameters .