摘要
目的 观察Narcotrend监测在腔镜甲状腺切除术快通道麻醉中应用的效果,评价Narcotrend监测在快通道麻醉中应用的可行性.方法 择期行腔镜甲状腺切除术患者100例,按随机数字表法分为N组（Narcotrend监测组）和C组（对照组）,每组50例.两组均以丙泊酚、瑞芬太尼、阿曲库铵行麻醉诱导和麻醉维持并行Narcotrend监测,N组和C组术中分别根据Narcotrend指数（NI）或临床体征和临床经验调整丙泊酚和瑞芬太尼用量.两组术后进行Steward评分,以术毕10 min内Steward评分≥4分拔除喉罩者为快通道麻醉实施成功.记录两组麻醉诱导前（T1）、喉罩置入（T2）、切皮（T3）、充气后10 min （T4）、充气后30 min （T5）、手术结束时（T6）、拔除喉罩前（T7）、拔除喉罩后5 min（T8）的NI.记录麻醉药用量、苏醒时间、拔除喉罩时间、快通道麻醉成功情况、术中知晓情况、术后恶心呕吐、术后躁动发生情况.结果 N组NI高于C组（F=192.363,P=0.000）,组间与时间点存在交互作用（F=48.254,P=0.000）;N组T3、T4、T5和T6NI均明显高于C组（58.2±5.3比44.6±6.7、55.3±6.8比39.5±7.1、54.6±6.6比36.3±6.7、65.2±5.5比56.3±7.4）,差异有统计学意义（P＜0.01）.两组瑞芬太尼、阿曲库铵用量比较差异均无统计学意义（P＞0.05）;N组丙泊酚用量明显小于C组[（462±86）mg比（635±120） mg],苏醒时间和拔除喉罩时间均明显短于C组[（5.2±1.3）min比（8.9±2.2） min、（7.3±2.5） min比（12.5±3.1） min],快通道麻醉成功率明显高于C组[84.0％（42/50）比44.0％（22/50）],术后恶心呕吐发生率低于C组[4.0％（2/50）比16.0％（8/50）],差异有统计学意义（P＜0.01或＜0.05）.两组术中知晓（N组无术中知晓,C组有3例）、术后躁动发生率比较差异均无统计学意义（P＞0.05）.结论 Narcotrend监测用于腔镜甲状腺切除术快通道麻醉,有利于对麻醉深度的调控,避免麻醉过深或过浅,防止术中知晓;同时可以减少全身麻醉药用量,促进患者术后尽早复苏,提高快通道麻醉成功率,降低术后恶心呕吐等不良反应的发生率.
Objective To investigate the effect of Narcotrend monitoring in fast-track anesthesia for endoscopic thyroidectomy,and evaluate the feasibility of application of Narcotrend monitoring in fast-track anesthesia.Methods One hundred patients who undergoing endoscopic thyroidectomy were divided into group N （Narcotrend monitoring group,50 cases） and group C （control group,50 cases） by random digits table method.All patients were induced and maintained with propofol,remifentanil and atracurium while monitored by Narcotrend,propofol and remifentanil infusion rate were adjusted in two groups according to Narcotrend index （NI） and the clinical standard practice during operation.Steward score was assessed postoperative to test for success of fast-track anesthesia （Steward score≥4 points within 10 min）.NI in two groups were recorded at time points：before induction of anesthesia （T1）,at laryngeal mask airway（LMA） insertion（T2）,skin incision （T3）,10 min（T4） and 30 min（T5） after CO2 sufflation,at the end of operation （T6）,just before LMA removal （T7）,5 min after LMA removal （Ts）.Anesthetic dosage,recovery time,LMA removal time,intraoperative awareness,postoperative nausea and vomiting （PONV）,postoperative agitation were recorded and the success rate of fast-track anesthesia of each group was calculated.Results NI of group N was higher than that of group C （F =192.363,P =0.000）,and there was interaction between groups and time points （F =48.254,P =0.000）.NI of group N was significantly higher than that of group C at T3,T4,T5,T6 （58.2 ± 5.3 vs.44.6 ± 6.7,55.3 ± 6.8 vs.39.5 ± 7.1,54.6 ± 6.6 vs.36.3 ± 6.7 and 65.2 ± 5.5 vs.56.3 ±7.4）,and there were statistical differences （P ＜0.01）,but there was no statistical differences between two groups at T1,T2,T7,T8 （P ＞ 0.05）.There was no statistical difference in amount of remifentanil and atracurium between two groups （P ＞ 0.05）.The amount of propofol,recovery time and LMA removal time of group N were significantly less than those of group C [（462 ± 86） mg vs.（635 ± 120） mg,（5.2 ± 1.3） min vs.（8.9 ± 2.2） min and （7.3 ± 2.5） min vs.（12.5 ± 3.1） min,P ＜ 0.01].The success rate of fasttrack anesthesia of group N was significantly higher than that of group C [84.0％（42/50） vs.44.0％（22/50）,P ＜ 0.01].The rate of PONV of group N was lower than that of group C [4.0％（2/50） vs.16.0％ （8/50）],and there was significant difference （P ＜ 0.05）.There was none of intraoperative awareness in group N while 3 cases in group C,but with no statitical difference between two groups （P＞ 0.05）.There was no statistical difference in postoperative agitation between two groups（P ＞ 0.05）.Conclusions Narcotrend monitoring in fast-track anesthesia for endoscopic thyroidectomy is conductive to optimizing depth of anesthesia,may avoid deep or light anesthesia and prevent intraoperative awareness; at the same time,it can reduce the anesthetic dosage,speed up recovery and increase the success rate of fast-track anesthesia,also reduce the rate of PONV.
出处
《中国医师进修杂志》
2014年第3期8-11,共4页
Chinese Journal of Postgraduates of Medicine
基金
广东省中山市科技计划（20132A149）
