校正NI值指导复合小剂量艾司氯胺酮用于程控性闭环靶控输注系统的效果  

Efficacy of adjusted NI value guidance combined with small-dose esketamine for program-controlled closed-loop target-controlled infusion system

作　　者：李胜超 李晓珊 何洹 邵伟栋 徐婵晏 张兴安 徐波 Li Shengchao;Li Xiaoshan;He Huan;Shao Weidong;Xu Chanyan;Zhang Xing′an;Xu Bo(Department of Anesthesiology,General Hospital of Southern Theater Command of PLA,Guangzhou 510010,China)

机构地区：[1]南部战区总医院麻醉科,广州510010

出　　处：《中华麻醉学杂志》2024年第4期428-432,共5页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金项目(62076253);广东省重大专项科技计划(2021B0101410005)。

摘　　要：目的评价校正Narcotrend指数(NI)值指导复合小剂量艾司氯胺酮用于程控性闭环靶控输注系统的效果。方法择期全身麻醉下行腹腔镜手术患者48例,性别不限,年龄18~55岁,BMI 18~25 kg/m^(2),ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为对照组(C组,NI基线值36)和校正组(E组,NI基线值46),每组24例。选择丙泊酚和瑞芬太尼效应室靶浓度后进行麻醉诱导和维持,维持期NI值稳定于26~46后,E组给予小剂量艾司氯胺酮(静脉注射0.2 mg/kg,随后以5μg·kg^(-1)·min^(-1)泵注30 min),C组给予等量生理盐水。随后开始程控性闭环靶控输注,每隔5 min根据各预设的NI基线值调节丙泊酚和瑞芬太尼效应室靶浓度。主要指标:给予艾司氯胺酮后1 h内NI值目标范围内时间比率;次要指标:丙泊酚和瑞芬太尼用量、术后恢复时间、术后1 h内恶心呕吐、疼痛和寒战发生率。术后第2天随访患者术中知晓情况。结果2组程控性闭环靶控输注系统的性能均在临床安全阈值范围,无术中知晓发生。与C组比较,E组丙泊酚和瑞芬太尼用量减少(P<0.05)。2组患者NI值目标范围内时间比率、术后恢复时间及不良反应发生率比较差异无统计学意义(P>0.05)。结论校正NI值指导复合小剂量艾司氯胺酮用于程控性闭环靶控输注系统的效果较好。Objective To evaluate the efficacy of adjusted Narcotrend Index(NI)value guidancecombined with small-dose esketamine for program-controlled closed-loop target-controlled infusion(TCI)system.Methods Forty-eight American Society of Anesthesiologists Physical Status classificationⅠorⅡpatients,regardless of gender,aged 18-55 yr,with body mass index of 18-25 kg/m^(2),scheduled for elective laparoscopic surgery under general anesthesia,were assigned to control group(group C,NI baseline value median 36)and esketamine group(group E,NI baseline value median 46)using a random number table method,with 24 cases in each group.Anesthesia induction and maintenance were carried out using effect-site concentration TCI(Schnider model for propofol infusion and Minto model for remifentanil infusion).After the NI value was maintained at 26-46 during anesthesia maintenance,a small dose of esketamine was given(as an intravenous bolus 0.2 mg/kg,followed by an infusion of 5μg·kg^(-1)·min^(-1)for 30 min)in group E,and the equal volume of normal saline was given instead in group C.Program-controlled closed-loop TCI was then started,and the target effect-site concentrations of propofol and remifentanil were adjusted every 5 min according to the corresponding preset NI baseline value.The main outcome measures were the percentage of time of NI value maintained in the target range within 1 h after administration of esketamine.Secondary outcome measures were the consumption of propofol and remifentanil,postoperative recovery time,incidence of nausea and vomiting,pain and shivering within 1 h after surgery.Patients were followed for intraoperative awareness on 2nd day after operation.Results The performance of the program-controlled closed-loop TCI systems was within the safe clinical threshold,with no intraoperative awareness occurred in both groups.The consumption of propofol and remifentanil was significantly reduced in group E as compared to group C(P<0.05).There were no statistically significant differences in the percentage of time

关 键 词：环己烷类 药物释放系统 NARCOTREND指数 

分 类 号：R614[医药卫生—麻醉学]