Narcotrend监测下丙泊酚靶控输注技术在肾移植患者全麻诱导期的应用

目的探讨Narcotrend监测下丙泊酚靶控输注(TCI)技术在肾移植患者全麻诱导期的应用对心血管及应激反应的影响。方法选择择期行亲属活体肾移植手术的尿毒症患者40例,男25例,女15例,年龄21~38岁,ASAⅢ或Ⅳ级,随机分为A、B两组,每组20例。A组在Narcotrend监测下采用Diprifusor TCI输注泵输注丙泊酚,B组人工推注丙泊酚。记录麻醉诱导前(T_0)、气管插管前(T_1)、气管插管后1 min(T_2)、3 min(T_3)、5 min(T_4)的HR、MAP、Narcotrend指数(NTI)及血糖(Glu)、血浆皮质醇(Cor)浓度。结果与T0时比较,T1时两组患者HR明显减慢,MAP明显下降(P0.05),且B组明显低于A组(P0.05);T_2、T_3时B组HR明显增快,MAP明显升高(P0.05),且B组明显高于A组(P0.05)。与T_0时比较,T2~T4时A组Glu、Cor略有升高,但差异无统计学意义;T_2~T_4时B组Glu、Cor浓度明显升高(P0.05),且B组明显高于A组(P0.05)。结论 Narcotrend监测下丙泊酚TCI用于肾移植患者全麻诱导时,麻醉深度可控性强,能有效减轻气管插管引起的机体应激反应,维持血流动力学平稳。

Observation on the clinical application of target-controlled infusion of propofol guided by Narcotrend for anesthetic induction in renal transplantation patients

Objective To observe the hemodynamic change and stress reaction of target-con-trolled infusion (TCI)of propofol guided by Narcotrend for anesthetic induction in renal transplanta-tion patients.Methods Forty patients (25 males,1 5 females,aged 21-38 years,ASA grade Ⅲ orⅣ)undergoing related living donor kidney transplantation were randomly divided into two groups:group A and group B (n =20).Group A was induced using TCI system with propofol under the moni-toring of Narcotrend.Group B was induced with propofol manually.HR,MAP,Narcotrend index (NTI),blood glucose (Glu)and plasma cortisol (Cor)were measured before induction (T0 ),before tracheal intubation (T1 ),and 1 (T2 ),3 (T3 ),and 5 (T4 )minutes afterwards.Results HR and MAP at T1 were lower than those at T0 (P < 0.05 )in two groups,they were significantly lower in group B than in group A at corresponding points(P <0.05).HR and MAP in group B increased sig-nificantly (P <0.05)and were significantly higher than those in group A (P <0.05)at T2 and T3 . There was no obvious difference in Glu and Cor between T0 and T2-T4 in group A.Glu and Cor at T2-T4 were obviously higher than those at T0 (P <0.05)in group B and those at corresponding points in group A (P <0.05).Conclusion TCI of propofol guided by Narcotrend in renal transplantation pa-tients can better control the depth of anesthesia,attenuate the stress reaction caused by tracheal intu-bation,and keep hemodynamic smooth during anesthesia induction.