Narcotrend 指导下不同麻醉深度对喉罩置入时机的影响

摘要

目的：观察静脉输注丙泊酚、舒芬太尼麻醉诱导后，根据 Narcotrend 指数（NT 值）指导喉罩置入时机的可行性研究。方法：60例择期全身麻醉患者，ASAⅠ或Ⅱ级，经静脉输注丙泊酚、舒芬太尼麻醉诱导后，根据喉罩置入即刻 NT 值分为三组：64~57组（Ⅰ组）、56~37组（Ⅱ组）、﹤36组（Ⅲ组），每组20例。观察患者置管条件和置管前后血流动力学变化。结果：Ⅰ组患者喉罩置入时，患者张口度差、呛咳及体动等麻醉过浅反应明显多于Ⅱ、Ⅲ组，置管后患者血压、心率较置管前显著升高（均 P＜0.05）。Ⅲ组患者置管前后血压及心率均较基础值显著下降，且显著低于Ⅰ、Ⅱ组患者，超过半数患者需要使用麻黄素和阿托品，同时15例出现呼吸抑制，发生例数显著高于Ⅱ、Ⅲ组（均 P＜0.05）。结论：NT 值为56~37时，患者的置管条件较好、血流动力学较平稳，是喉罩置入合适时机。%Objective:To investigate the feasibility of optimal timing of laryngeal mask airway( LMA) guided by Narcotrend index( NTI) after induction of anesthesia with intravenous propofol and sufentanil. Methods:Sixty patients with ASA grade I or grade II scheduled for elective general anesthesia were included in the study. After the induction of anesthesia with intravenous propofol and sufentanil,all patients were divided into three groups(n= 20 each)according to NTI at the time of LMA intubation. The NTI was 64~57 in group I,56~37 in group II,and<36 in group Ⅲ. The intubation condition and hemodynamic changes before and after the intubation in patients were determined.Results:During the intubation of LMA,signs of inadequate anesthesia such as worse mouth opening,choking and movement,were found significantly more in group I compared with group II and group Ⅲ. After the intubation,the blood pressure and heart rate in group I were significantly higher than those before the intubation. Before and after the intubation,the blood pressure and heart rate in group Ⅲsignificantly decreased compared with baseline,and were significantly lower than those in group I and group II. More than half of the patients in group Ⅲ needed ephedrine and atropine. Meanwhile,respiratory depression occurred in 15 patients,which was significantly more than those in group II and group Ⅲ.Conclusion:when NTI is between 37 and 56,well intubation condition and stable hemodynamics may be achieved in the patients, suggesting a suitable intubation occasion of LMA.