Narcotrend监测在丙泊酚靶控输注气管拔管的临床应用  

Extubation under the level of sedation with propofol target-controlled infusion guided by Narcotrend

作　　者：鞠志海[1] 钟涛[1] 金莲锦[1] 刘再英[1] 韩继成[1] 郭曲练[1] 

机构地区：[1]中南大学湘雅医院麻醉科,长沙市410008

出　　处：《临床麻醉学杂志》2013年第8期738-741,共4页Journal of Clinical Anesthesiology

摘　　要：目的观察围拔管期用Narcotrend监测指导丙泊酚靶控输注(TCI),评估其抑制拔管反应的效果。方法择期全麻下行腹式子宫切除术患者40例,随机均分为两组。N组术毕继续TCI丙泊酚,并调节丙泊酚的预测效应室浓度,使围拔管期Narcotrend指数(NTI)维持在65～79。C组术毕时停止TCI丙泊酚。记录入室时(T1)、术毕(T2)、吸痰(T3)、拔管时(T4)及拔管后5min(T5)和10min(T6)的HR、SBP、DBP及RPP,以及呛咳反应、自主呼吸恢复时间、苏醒时间和麻醉舒适度评分。结果与T1时比较,T3、T4时C组RPP明显升高(P<0.05),T4时C组SBP明显升高(P<0.05)。与N组比较,T3～T5时C组SBP、DBP和RPP明显升高(P<0.05),T3、T4时C组HR明显增快(P<0.05)。N组麻醉舒适度评分明显高于C组(P<0.05)。结论术毕在Narcotrend监测下TCI丙泊酚使NTI维持在65～79拔管可以减轻血流动力学波动及呛咳反应,提高麻醉舒适度。Objective To investigate the effects of Narcotrend on hemodynamics response, incidence of cough and recovery profiles at extubation during emergence from anesthesia with a propofol target-controlled infusion. Methods Forty patients ASA physical status I or ]] scheduling for elective gynecological abdominal surgery were randomly divided into two groups： Narcotrend group （group N） and control group （group C）, 20 cases in each group. At the end of the operation, the patients in group N were continued to keep a certain depth of anesthesia with propofol target- controlled infusion guided by Narcotrend. The predicted effect compartment concentration of propofol were adjusted to keep the value of Narcotrend Index （NTI） in a steady range from 65 to 79 while the group C without propofo[ infusion. BP, HR, RPP（rate pressure product） were observed at the time of entering operation room（T1）, at the end of surgery（T2 ）, at sputum suction（T3 ）, at extubating （T4）, 5 rain and 10 min after extubation（Tb, T6）. Also cough reflex at the point of endotracheal suction and extubation, the spontaneous respiration recovery time and recovery time were evaluated. Results In group C, RPP at Ta and T4 and SBP at T4 was significantly increased than that at Tt. Group N showed significantly smaller hemodynamic changes and lower cough scores at endotracheal suction and extubation compared to group C. Conclusion Propofol, when given with target-controlled infusion guided by Narcotrend at the end of surgery, attenuated the hemodynamic fluctuation, cough reflex associated with emergence from anaesthesia, and improved the patients^comfort feeling.

关 键 词：Narcotrend监测 靶控输注 血流动力学 丙泊酚 

分 类 号：R614[医药卫生—麻醉学]