不同剂量舒芬太尼对神经外科手术患者气管插管时心血管反应和Narcotrend指数的影响  

Effect of different doses of sufentanil on cardiovascular response and Narcotrend index during tracheal intubation in neurosurgery patients

作　　者：赵丽[1] 张慧文 张永海[1] 杨凡[1] 翟霭 丁丽 马汉祥[1] ZHAO Li;ZHANG Huiwen;ZHANG Yonghai;YANG Fan;ZHAI Ai;DING Li;MA Hanxiang(Department of Anesthesiology,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院麻醉科,宁夏银川750004

出　　处：《宁夏医学杂志》2022年第9期776-780,共5页Ningxia Medical Journal

基　　金：宁夏重点研发计划项目(2021BEG03048,2021BEG03073)。

摘　　要：目的通过观察患者气管插管前后血流动力学指标、脉搏灌注指数(PI)和Narcotrend指数(NTI)的变化,研究不同剂量舒芬太尼对神经外科手术患者气管插管时心血管反应及麻醉深度的影响。方法选择神经外科择期手术患者90例,随机分为舒芬太尼低剂量组(LS组)、中剂量组(MS组)和高剂量组(HS组),患者依次静脉注射咪达唑仑0.03 mg/kg、依托咪酯0.15~0.3 mg/kg,待患者意识消失后,LS组、MS组和HS组患者分别静脉注射舒芬太尼0.5μg/kg、0.75μg/kg和1μg/kg(注射速度为1μg/s),之后静脉注射罗库溴铵0.6 mg/kg,面罩通气5 min后插入气管导管(气管插管均在30 s内完成)。记录患者诱导前(T_(1))、意识消失时(T_(2))、插管前(T_(3))、插管即刻(T_(4))、气管插管后1 min(T_(5))、气管插管后3 min(T_(6))、气管插管后5 min(T_(7))的心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、脉搏灌注指数(PI)及Narcotrend指数(NTI),比较不同剂量舒芬太尼对神经外科手术患者气管插管时心血管反应、PI及NTI的影响。结果T_(4)、T_(5)时3组患者HR、SBP较T_(3)时均显著上升且3组组间比较差异有统计学意义(P<0.05),其中LS组上升程度最明显,HS组上升程度均低于LS组、MS组(P<0.05)。DBP、MAP在T_(4)时LS组上升最明显,3组组间比较差异有统计学意义(P<0.05)。LS组、MS组HR、SBP在T_(7)时降至基础水平,但HS组在T_(4-7)时SBP均低于基础值水平,3组比较差异有统计学意义(P<0.05)。3组病人在T_(1-2)时NTI、PI组间比较差异均无统计学意义(P>0.05),T_(3)时HS组NTI下降最明显(P<0.05)。T_(4-5)时NTI明显上升,3组组间比较差异有统计学意义(P<0.05)。T_(4-5)时PI较T_(1)与T_(3)时明显下降(P<0.05),LS组、MS组下降更为显著(P<0.05)。T_(7)时PI恢复至基础水平。结论神经外科手术患者全麻诱导期间静脉注射0.75μg/kg舒芬太尼血流动力学更加平稳。NTI随着舒芬太尼剂量增大而降低。PI的变化�Objective To explore the effects of different doses of sufentanil on the cardiovascular response and the depth of anesthesia during tracheal intubation by observing the hemodynamic indexes,pulse perfusion index(PI)and Narcotrend index(NTI)before and after tracheal intubation in neurosurgery patients.Methods A total of 90 patients undergoing elective neurosurgery surgery were selected and randomly divided into low-dose sufentanil group(LS group),medium-dose group(MS group)and high-dose group(HS group).The patients were intravenously injected with midazolam 0.03 mg/kg and etomidate 0.15~0.3 mg/kg.After the patient′s consciousness disappeared,the patients in the LS group,MS group and HS group were intravenously injected with sufentanil 0.5μg/kg and 0.75μg/kg respectively(the injection rate was 1μg/s),followed by intravenous injection of rocuronium 0.6 mg/kg,and tracheal intubation was inserted after mask ventilation for 5 minutes(tracheal intubation was completed within 30 s).Recording the patient′s heart rate(HR)systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),PI and NTI at before induction(T_(1)),the time of unconsciousness(T_(2)),before intubation(T_(3)),immediately after intubation(T_(4)),1 min(T_(5)),3 min(T_(6)),and 5 min(T_(7))after tracheal intubation,and the effects of different doses of sufentanil on cardiovascular response,PI and NTI during endotracheal intubation in neurosurgery patients were compared.Results At T_(4) and T_(5),the HR and SBP of the three groups were significantly increased compared with those at T_(3),and there was a statistical difference among the three groups(P<0.05).Among them,the LS group had the most obvious increase,and the HS group had a lower increase than the LS and MS groups(P<0.05).At T_(4),DBP and MAP increased most significantly in the LS group,and there was a statistical difference among the three groups(P<0.05).HR and SBP in LS group and MS group decreased to the basal level at T_(7),but SBP in HS group was lower than the basa

关 键 词：舒芬太尼 气管插管反应 NARCOTREND指数 脉搏灌注指数 

分 类 号：R714.252[医药卫生—妇产科学]