Narcotrend监测下七氟醚对脊柱侧弯矫正术中唤醒的影响  

Effect of inhalational sevoflurane guided by Narcotrend monitoring on intraoperative wake-up test in scoliosis correction surgery

作　　者：农丽丹[1] 李海风[1] 孙怡[1] 

机构地区：[1]广东省人民医院,广东省医学科学院麻醉科,广州市510080

出　　处：《实用医学杂志》2012年第18期3052-3054,共3页The Journal of Practical Medicine

摘　　要：目的:观察Narcotrend麻醉深度监测在脊柱侧弯矫正术中唤醒试验的应用,评价七氟醚对脊柱侧弯矫正术中唤醒试验的影响。方法:60例择期行脊柱侧弯矫正术患者,ASAⅠ～Ⅱ级,随机分为七氟醚复合瑞芬太尼静吸复合组(S组)和丙泊酚复合瑞芬太尼静脉麻醉组(P),每组30例。以丙泊酚复合瑞芬太尼靶控输注诱导,诱导插管成功后S组吸入低流量七氟醚(1L/min),P组靶控输注丙泊酚维持麻醉。两组术中均靶控输注瑞芬太尼。根据Narcotrend麻醉深度监测把NI值维持在30～45调整麻醉深度。记录两组患者手术开始至唤醒试验的时间、手术时间、唤醒时间(从开始唤醒至唤醒成功时间)及苏醒时间(唤醒后清醒时间);观察唤醒试验期间有无不良反应发生,记录两组麻醉前(T0)、术中唤醒前停药时(T1)、唤醒时(T2)、唤醒后10min(T3)、术毕拔管(T4)时平均动脉压(MAP)、心率(HR)、NI值及呼吸末七氟醚的浓度(ETsev)。术后1d,随访患者对唤醒试验及术中其他事件的记忆情况及术中有无疼痛等。结果:两组两组患者均成功完成唤醒试验。两组患者手术开始至唤醒试验的时间、手术时间、唤醒时间和苏醒时间比较差别均无统计学意义(P>0.05)。唤醒期间丙泊酚组有2例发生呛咳,七氟醚组无发生呛咳患者。术后随访两组患者无神经损伤表现,对术中其他事件无记忆。术中两组患者唤醒试验唤醒时(T2)及术毕拔管时(T4)的MAP和HR值较其他时间点均明显升高(P<0.05);两组患者在唤醒前停药时(T1)及唤醒后10min(T3)的NI值较其他时间点均明显降低(P<0.05);七氟醚组在唤醒前停药时(T1)及唤醒后10min(T3)的ETsev值较其他时间点升高(P<0.05);两组各时间点的MAP、HR及NI值比较差别无统计学意义(P>0.05)。结论:在Narcotrend麻醉深度监测指导下吸入七氟醚同丙泊酚一样适用于脊柱侧弯矫正术中唤醒麻醉,Narcotrend麻醉深度监测对脊柱矫形�[Abstract] Objectives The purpose of this paper was to evaluate the effect of inhalational sevoflurane guided by Narcotrend monitoring on intraoperative wake-up test in scoliosis correction surgery. Methods Sixty ASA Ⅰ -Ⅱ patients undergoing elective scoliosis correction surgery were randomly assigned to two equal groups receiving sevoflurane/remifentanil （Group S） or propofol/remifentanil （Group P）. Anesthesia was maintained with low-flow （1 L/rain） inhalation of sevoflurane in group S and target-controlled infusion of propofol in group P. Remifentanil was target-controlled infused in two groups.The time from starting of operation to wake-up test, operation time, wake-up test time, analepsia time were recorded. Mean arterial blood pressure （MAP）, heart rate （HR）, N] and end-tidal sevoflurane （ETsev） were recorded before anaesthesia （TO）, drug stopped before wake-up （T1）, wake-up （T2）, 10 minutes after wake-up （T3） and extubate （T4）. Retention condition about the wake-up test and other intraoperative events were follow-up visited at 1 day after operation. Results All patients in two groups woke up successfully. The differences of the time from starting of operation to wake-up test, operation time, wake-up test time, analepsia time between two groups were not statistically significant （P 〉 0.05 ）. Two cases were bucking in group P, while no one in group S. All patients could not recall the wake-up test and other intraoperative events. During the operation, MAP and HR at T2 and T4 were higher than those at other time （P 〈 0.05 ）, while NI were lower at TI and T3 in two groups （P 〈 0.05）. ETsev at T1 and T3 were higher than those at other time ingroup S （P 〈 0.05） . The differences of MAP, HR and BIS at all times between two groups were not statistically significant （P 〉 0.05 ）. Conclusions Under the guidance of depth of anesthesia monitoring, both sevoflurane inhalation anesthesia and propofol are appropiate anesthetic skills for scoliosi

关 键 词：NARCOTREND 七氟醚 丙泊酚 唤醒试验 

分 类 号：R614[医药卫生—麻醉学]