切痂植皮术中应用Narcotrend监护仪监测盐酸瑞芬太尼复合二异丙酚靶控输注麻醉深度的临床观察  

Application of Narcotrend-assisted anesthesia in-depth monitor during escharectomy and skin trans- plantation in burn patients with target-controlled infusion of remifentanil hydrochloride and propofol

作　　者：郭正纲[1] 王晓燕[1] 吕绪磊[1] 苏小军[1] 郝建华[1] 

机构地区：[1]解放军总医院第一附属医院麻醉科,北京100048

出　　处：《中华烧伤杂志》2012年第3期178-182,共5页Chinese Journal of Burns

摘　　要：目的评价重度烧伤患者围手术期应用Narcotrend监护仪监测盐酸瑞芬太尼复合二异丙酚靶控输注麻醉的可行性及有效性。方法选择2011年2-11月笔者单位择期（伤后1周以内）行焦痂切除植皮术的重度烧伤患者80例，美国麻醉医师协会分级为Ⅱ-Ⅲ级，烧伤总面积为31％-50％或Ⅲ度面积11％-20％TBSA，按照随机数字表法分为试验组（常规方法结合Narcotrend监护仪监测麻醉深度）和对照组（常规方法监测麻醉深度），每组40例。2组患者均以盐酸瑞芬太尼复合二异丙酚靶控输注诱导和维持麻醉；术中试验组所用Narcotrend监护仪维持D1-E1级，对照组维持平均动脉压（MAP）、心率在基础值的20％范围内波动，并以此为参照调整2种麻醉药物靶控浓度。记录患者麻醉维持过程中盐酸瑞芬太尼和二异丙酚靶控浓度；记录患者停药至苏醒期时间，包括从停药至呼之睁眼、停药至定向力恢复2个时间段；记录患者入室时，意识消失时，插管后2min，手术前，手术开始后2、15、30min，术毕时的MAP和心率；记录试验组监测参数Narcotrend分级（NTS）和Narcotrend指数（NTI）及对照组监测参数MAP、心率对停药至苏醒期2个时问段的预测概率（Pk）值。统计2组患者心血管活性药物使用情况及患者术中知晓情况。对数据进行t检验、方差分析、X^2检验，其中NTS、NTI、MAP、心率与其对停药至定向力恢复时间的Pk值行Spearman相关分析。结果试验组患者围手术期盐酸瑞芬太尼靶效应室浓度、二异丙酚靶血浆浓度分别为（2．62±0．35）ng／mL、（3．84±0．22）μg／mL，均低于对照组[（2．95±0．21）ng／mL、（4．16±0．31）μg／mL，t值分别为-5．113、-5．324，P值均小于0．01]。试验组患者从停药至呼之睁眼、停药至定向力恢复的时间分别为（10．2±0．7）、（11．1±1．0）min，均明显短于对照组[（11．3±1．0�Objective To evaluate the feasibility and efficacy of Narcotrend （NT） monitor in moni- toring the depth of anesthesia in severely burned patients with target-controlled infusion （TCI） of remifen- tanil hydrochloride and propofol during perioperative period. Methods Eighty patients with severe burn hospitalized from February to November 2011, to whom eschar excision was performed within one week after injury, were enrolled. They were classified into Ⅱ to Ⅲ grade according to the American Society of Anesthe- tists classification, and their total burn area ranged from 31% to 50% TBSA, or full-thickness burn area from 11% to 20% TBSA. Patients were divided into trial group （monitoring depth of anesthesia with routine method and NT monitor） and control group （monitoring depth of anesthesia with routine method） according to the random number table, with 40 cases in each group. All patients received TCI of remifentanil hydro- chloride and propofol to induce and maintain anesthesia. During the operation, the anesthesia level of NT monitor used in the trial group was maintained from grade D1 to E0, while the fluctuation of mean arterial pressure （MAP） and heart rate of patients in control group was maintained around the basic values within a range of 20% , and on the basis of which, concentrations of two narcotics were adjusted. Concentrations of remifentanil hydrochloride and propofol during maintenance of anesthesia were recorded. The duration from drug withdrawal to waking from anesthesia （including the duration from drug withdrawal to eye opening by calling and the duration from drug withdrawal to orientation recovery） of patients was recorded. Values of MAP and heart rate at admission into the operation room, loss of consciousness, 2 rain after intubation, be- fore operation, 2, 15, and 30 rain after the beginning of operation, and the end of operation were recorded. The prediction probability （ P k） of NT stage （NTS） and NT index （NTI） in trial group, and that of MAP and heart

关 键 词：烧伤 麻醉 二异丙酚 靶控输注 Narcotrend监护仪 

分 类 号：R614[医药卫生—麻醉学]