NarcoTrend反馈调控丙泊酚靶控输注联合舒芬太尼靶控输注静脉麻醉的临床效果

摘要

目的：探讨Narcotrend反馈调控丙泊酚靶控输注静脉麻醉联合舒芬太尼靶控输注在妇科腹腔镜手术中应用的临床效果。方法：择期腹腔镜下子宫次全切除术的患者100例，ASA Ⅰ~Ⅱ级，随机分为4组（ n＝25）：Narcotrend反馈丙泊酚麻醉联合舒芬太尼靶控组（ NS组）；舒芬太尼靶控组（ S组）；Narcotrend反馈丙泊酚麻醉组（ N组）；对照组（ C组）。Narcotrend反馈控制变量定在35。丙泊酚效应室靶浓度设定为3μg/ml，舒芬太尼效应室靶浓度设定为0.4 ng/ml，麻醉期维持靶浓度不变。记录诱导前患者清醒状态下（T0）、MOAA/S评分≤1时（T1）、气管插管后（T2）、切皮时（T3）、切皮后5 min（T4）、术毕停药（T5）、拔管时（ T6）各时间点的HR、MAP；记录丙泊酚的使用剂量、计算丙泊酚单位标准化剂量、患者苏醒时间及定向力恢复时间。结果：Narco-trend反馈调控丙泊酚麻醉与舒芬太尼靶控可产生协同作用，可使MAP更稳定（P＝0.0286）；降低丙泊酚总量（P＝0.0379）和丙泊酚单位标准化量（P＝0.0250）；缩短苏醒时间（P＝0.0122）与定向力恢复时间（P＝0.0183）；但对HR不存在交互效应（P＝0.5703）。结论：Narcotrend作为丙泊酚靶控反馈调控变量应用于妇科腹腔镜手术全身麻醉是可行的，与舒芬太尼靶控输注可使术中血压更平稳，减少丙泊酚使用量，苏醒快，提高麻醉复苏质量。%Objective To explore the clinical effects of target controlled infusion( TCI)of sufentanil combined with feedback from Nar-cotrend for patients undergoing gynecological laparoscopic operation. Method One hundred ASA I ~II patients undergoing Laparoscopic subtotal hysterectomy were randomly allocated to four groups of twenty-five each:sufentanil with TCI combined with feedback from Narco-trend( NS group),sufentanil with TCI( S group),feedback from Narcotrend( N group)and control group( C group). Narcotrend value of 35 was set as the control variable. The target effect-site concentration of propofol was set as 3μg/ml and the target effect-site concentra-tion of sufentanil was set as 0. 4ng/ml throughout anesthesia. HR and MAP of all patients were recorded before induction of anaesthesia ( T0 ),at the time of MOAA/S≤1( T1 ),at the time of tracheal intubation( T2 ),immediately( T3 )and at 5 minutes( T4 )after skin inci-sion,at the end of dosing( T5 )and at the time of extubation( T6 ). The total dose of propofol,the standardized unite dose of propofol,the time for emergence and the time for regaining orientation were recorded. Results Sufentanil with TCI combined with feedback from Narco-trend could make synergistic effect,it could make MAP more stable( P=0. 028 6﹤0. 05),reduce the total dose of propofol( P=0. 037 9﹤0. 05)and standardized unite dose of propofol( P=0. 025 0﹤0. 05),shorten the time for emergence( P=0. 012 2﹤0. 05)and the time for regaining orientation(P=0. 018 3﹤0. 05);but there was no interaction effect on HR(P=0. 570 3>0. 05). Conclusion Narcotrend used as a feedback control is useful in propofol anaesthesia with TCI,sufentanil TCI combined with feedback from Narcotrend for patients undergoing gynecological laparoscopic operation has the advantages of more stable blood pressure,less propofol,rapid emergence or orienta-tion and more accurate adjustment of depth of anesthesia.