Narcotrend指数指导丙泊酚和瑞芬太尼联合闭环靶控输注在颈椎手术中的临床应用  

Clinical application of closed-loop coadministration of propofol and remifentanil guided by Narcotrend index in cervical spine surgery

作　　者：刘秀英[1] 徐波[1] 马丽[1] 吴宗泽[2] 屠伟锋[1] 张兴安[1] 

机构地区：[1]广州中医药大学附属广州军区广州总医院麻醉科,广东广州510010 [2]广东工业大学自动化学院电子系,广东广州500006

出　　处：《暨南大学学报（自然科学与医学版）》2017年第3期247-252,共6页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：广东省科技计划项目(2014A020215026);军队后勤科研计划面上项目(CGZ15C003)

摘　　要：目的:评价Narcotrend指数(NI)指导丙泊酚和瑞芬太尼联合闭环靶控输注麻醉在颈椎手术中的应用价值.方法:纳入需行颈椎前路神经减压术的患者60例,ASA分级Ⅰ~Ⅲ级,随机分为两组:闭环组(A组)和人工组(B组).两组均以相同的方式诱导,当NI下降至≤46且持续30 s以上时,A组设置NI的目标值为36自动闭环靶控输注丙泊酚和瑞芬太尼;B组由麻醉医师手动调节丙泊酚和瑞芬太尼的靶质量浓度维持NI在(26~46).记录诱导前即刻(T_1)、诱导后即刻(T_2)、气管插管后1 min(T_3)、减压前(T_4)、减压后1 min(T_5)、减压后3 min(T_6)、减压后5 min(T_7)的心率(HR)、平均动脉压(MAP)和NI,计算两组丙泊酚、瑞芬太尼、阿托品、麻黄碱和乌拉地尔等药物使用量,不同麻醉深度(NI26~46、NI<26、NI>46)的时间比例及拔管时间.结果:与B组比较,A组充分麻醉NI26~46所占时间百分比升高,丙泊酚平均维持质量浓度降低,瑞芬太尼平均维持质量浓度增加,拔管时间缩短(P<0.05).结论:NI指导丙泊酚和瑞芬太尼联合闭环靶控输注应用于颈椎前路手术麻醉,术中可维持稳定的麻醉深度,与人工组相比,精确的调控方式使术中的血流动力学更加平稳,丙泊酚用量减少,苏醒更加迅速.Aim: To evaluate the use of narcotrend index(NI) in cervical spine surgery with propofol and remifentanil combined with closed loop target controlled infusion anesthesia. Methods: Sixty patients undergoing cervical spine surgery,ASAⅠ ~ Ⅲ,were divided into two groups: closed-loop group(group A) and open-loop group(group B). The two groups were induced in the same way,when NI drop to less than or equal to 46 and last for more than 30 s,Group A was set up for NI target controlled infusion of propofol and remifentanil for 36 automatic closed-loop target. Group B was under by anesthesiologistsmanual adjustment for propofol and remifentanil target concentrations in maintaining at NI of(26 ~ 46).The NI,mean arterial pressures(MAP) and heart rates(HR) were recorded: before induction(T_1),after intubation(T_2),1 min after endotracheal intubation(T_3),before decompression(T_4),1 min after decompression(T_5),3 min after decompression(T_6),5 min after decompression(T_7). Doses of propofol,remifentanil,atropine,ephedrine and urapidil in the two groups were analyzed. The time proportion of different anesthesia depth(NI26 ~ 46,NI < 26,NI > 46) and extubation time between the two groups were analyzed. Results: Compared with group B, the percentage of NI26 ~ 46 was significantly increased in group A(P < 0. 05). The mean maintenance of the dose for propofol was decreased,and that for remifentanil increased,but the time of extubation was shortened(P < 0. 05).Conclusion: NI guided propofol and remifentanil combined with closed-loop target-controlled infusion for cervical spine surgery anesthesia can maintain a stable anesthesia depth compared to the artificial group,the precise regulation of intraoperative blood flow is more stable,propofol consumption is decreased,and wake up is more quickly.

关 键 词：NARCOTREND 丙泊酚 瑞芬太尼 闭环靶控输注 颈椎手术 

分 类 号：R614.2[医药卫生—麻醉学]