Narcotrend监测下右美托咪定对全凭静脉麻醉甲状腺手术的影响  

Effects of dexmedetomidine on total intravenous anesthesia for thyroidectomy by Narcotrend monitoring

作　　者：马务迪 张涛[1] 张灵羿 黄文起[1] MA Wudi;ZHANG Tao;ZHANG Lingyi;HUANG Wenqi(Department of Anesthesiology,First Affliated Hospital,Sun Yatsen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院麻醉科,广东广州510080

出　　处：《麻醉安全与质控》2018年第3期137-140,共4页Perioperative Safety and Quality Assurance

摘　　要：目的探讨Narcotrend监测下右美托咪定在全凭静脉麻醉甲状腺手术中的临床应用和影响。方法选择中山大学附属第一医院收治的甲状腺手术患者120例,随机分为观察组(D组,n=60)和对照组(C组,n=60)。观察组:男25例,女35例,年龄24~71岁,平均年龄(42.83±5.73)岁,BMI 19.1~29.3 kg/m^2;对照组:男27例,女33例,年龄27~76岁,平均年龄(45.44±5.67)岁,BMI 18.5~29.1 kg/m^2。观察组诱导前10 min静脉泵注右美托咪定0.5μg/kg,对照组采用等容量的生理盐水静脉泵注。两组均使用靶控输注(TCI)丙泊酚4.0μg/m L、芬太尼3μg/kg、罗库溴铵0.6 mg/kg诱导插管。术中根据Narcotrend值(E_0~D_2)调整丙泊酚血浆靶浓度及瑞芬太尼,不追加肌肉松弛药。分别记录2组入室后(T_0)、诱导前(T_1)、入睡时(T_2)、插管后(T_3)、手术切皮时(T_4)、手术开始后30 min(T_5)、清醒拔管后(T_6)的平均动脉压(MAP)、心率(HR)、Narcotrend值、丙泊酚效应室靶浓度(Ce);记录2组患者诱导时入睡时间及苏醒时间,术中不良事件,拔管后呛咳反应,丙泊酚累积用量,术后VAS评分等情况。结果 T_1、T_2时2组HR、MAP均比T_0明显降低(P<0.05);T_3~T_5时,D组HR、MAP较T_0明显降低(P<0.05)。两组间对比,T_2~T_5时D组HR、MAP值明显低于C组(P<0.05);D组入睡时间及入睡时丙泊酚Ce均明显低于C组(P<0.05),苏醒时间和苏醒时丙泊酚Ce无明显差异;D组较多发生术中低血压,但较少发生拔管后呛咳;2组丙泊酚累积用量及VAS评分均无明显差异,均无术中知晓。结论 Narcotrend监测下在甲状腺手术诱导前应用右美托咪定不仅能够维持血流动力学稳定,而且加快诱导进程,使诱导时期丙泊酚用量减少,减少拔管呛咳,不影响患者术后复苏进程,有利于提高麻醉质量和安全系数,为较好的麻醉辅助药物。Objective To investigate the clinical use and effects of dexmedetomidine on total intravenous anesthesia for thyroid surgery under Narcotrened monitoring. Methods One hundred twenty thyroidectomy patients were randomized into two groups： dexmedetomidine group（ group D） and control group（ group C）. Ten minutes before induction of general anesthesia,intravenous dexmedetomidine（ 0. 5 μg/kg） was infused to group D,while group C received the same volume of saline. Target-controlled infusion（ TCI） of propofol（ initial 4. 0 μg/m L）,fentanyl（ 3 μg/kg）,rocuronium（ 0. 6 mg/kg） were applied in both groups during induction. Propofol and remifentanil were maintained and adjusted according to Narcotrend（ E0-D2） without additional muscle relaxants. MAP,HR,the value of Narcotrend,effect-site concentration of propofol（ Ce） were recorded at the time points respectively： before infusion（ T0）,before induction（ T1）,lose consciousness（ T2）,after intubation（ T3）,skin-cut（ T4）,intra-operation（ T5）,after extubation（ T6）. Time for losing and recovering consciousness,cough after extubation,propofol consumption,visual analogue scale（ VAS） and intraoperative awareness were recorded as well. Results Compared to T0,HR and MAP of both T1 and T2 dropped in two groups（ P〈0. 05）; group D had lower HR and MAP at T3-T5（ P〈0. 05）. Compared to group C,HR and MAP in group D had a significant decrease at T2-T5（ P〈0. 05）. Both time for losing consciousness and asleep-Ce reduced in group D（ P〈0. 05）. However,there were no difference in time for recovering consciousness and awake-Ce. Group D had more cases of hypotension but less coughing after extubation. It showed no difference in propo-fol consumption and VAS score. Conclusion The application of dexmedetomidine in thyroidectomy under Narcotrend monitoing can not only provide stable hemodynamics,but also reduce stress responses and propofol consumption without extended recovery time.

关 键 词：NARCOTREND 右美托咪定 甲状腺手术 丙泊酚 效应室靶浓度 

分 类 号：R614[医药卫生—麻醉学]