Narcotrend监测下七氟醚吸入对大脑皮质功能区手术术中唤醒试验的影响  

Effect of Sevoflurane Inhalation Guided by Narcotrend Monitoring on Intraoperative Wake-up Test in Patients Undergoing Operation in Functionally Related Cortical Areas

作　　者：黄建华[1] 高晓枫[1] 汪飞[1] 纪浩聪[1] 黎振平[1] 郭宗荣[1] 

机构地区：[1]惠州市第一人民医院麻醉科,广东惠州516003

出　　处：《实用临床医学（江西）》2014年第5期38-41,共4页Practical Clinical Medicine

摘　　要：目的：应用Narcotrend行麻醉深度监测，观察七氟醚吸入对大脑皮质功能区手术术中唤醒试验的影响。方法选择择期行脑功能区手术患者40例，ASAⅠ-Ⅱ级，按随机数字表法分为P组（异丙酚复合瑞芬太尼）和S组（七氟醚复合瑞芬太尼），每组20例。2组患者均采用异丙酚复合瑞芬太尼靶控输注诱导，喉罩插管成功后，P组持续TCI瑞芬太尼和异丙酚，S组持续TCI瑞芬太尼和吸入七氟醚，以Narcotrend监测麻醉深度，通过调整异丙酚靶控浓度或七氟醚吸入浓度，维持NTS在D0-D2，NI值在37~64。记录麻醉前（T0）、开始唤醒前（T1）、唤醒时（T2）、唤醒测试时（T3）、重新置入喉罩时（T4）各时点的平均动脉压（MAP）、心率（HR）、NI和ETsev值。记录2组患者的唤醒时间（从开始唤醒至唤醒成功的时间）及清醒时间（从开始唤醒至清醒配合测试时间）。观察唤醒过程中的不良事件发生情况。术后1d随访患者，记录术中知晓发生情况。结果2组患者均顺利完成唤醒试验，唤醒期间不良事件发生情况比较差异无统计学意义（P〉0.05），术后随访均无术中知晓发生。与T0比较，T1时点P组的MAP、2组的HR均降低，T2时点2组的MAP、HR均升高，差异有统计学意义（均P〈0.05）。2组患者麻醉后各时点的NI值均比T0降低（P〈0.05），唤醒时（T2、T3）较T1、T4升高（P〈0.05）。 S组ETsev值在唤醒时（T2、T3）较T1、T4时点均显著下降（P〈0.05）。2组在相同时点的MAP、HR和NI值比较差异无统计学意义（P〉0.05）。与P组比较，S组唤醒时间和清醒时间均缩短，差异均有统计学意义（均P〈0.05）。结论在大脑皮质功能区手术的唤醒试验中，七氟醚吸入复合瑞芬太尼靶控输注，术中循环稳定性好、唤醒时间短、苏醒快，较异丙酚唤醒质量更佳。采用Narcotend进行监测，可实时指导全身麻醉用药，维持合�Objective To investigate the effect of sevoflurane inhalation guided by Narcotrend monitoring on intraoperative wake-up test in patients undergoing operation in functionally related cortical areas. Methods Forty ASA Ⅰ or Ⅱ neurosurgical patients scheduled for elective surgery in cerebral functional areas were randomly divided into two groups, with 20 patients in each group. Anesthesia was induced by target-controlled infusion of propofol combined with remifentanil in all patients. After successful intubation through the laryngeal mask, anesthesia was maintained by target-controlled infusion of remifentanil and propofol in group P and by target-controlled infusion of remifentanil and inhalation of sevoflurane in group S. The Narcotrend was used to measure the depth of anesthesia . Narcotrend stage （ NTS ） was maintained at D0-D2 and Narcotrend index （ NI ） at 37-64 through adjusting target -controlled concentrations of propofol or inhalational concentrations of sevoflurane. Mean arterial blood pressure（MAP）,heart rate（HR）,NI and end-tidal sevoflurane conce-ntration （ETsev）were determined before anesthesia （T0）,before wake-up test （T1）,at the beginning of wake-up test （T2）, during wake-up test （T3） and after replacement of laryngeal mask （T4）. In addition, wake-up time （time from the beginning of wake-up to successful wake-up）, analepsia time （time from the beginning of wake-up to test cooperation） and adverse events during wake-up test were recorded in both groups. Intraoperative awareness was recorded 1 day after operation. Results Wake-up test was completed successfully and no intraoperative awareness occurred in all patients. There were no significant differences in the incidence of adverse events between the two groups during wake-up test （P〉0.05）. Compared with T0, MAP and HR decreased at T1 but increased at T2 in both groups（P〈0.05）. Furthermore, NI determined before anesthesia was less than that determined after anesthesia and NI determined at

关 键 词：大脑皮质功能区手术 七氟醚 唤醒试验 

分 类 号：R614[医药卫生—麻醉学]