Narcotrend监测TCI丙泊酚复合舒芬太尼或TCI瑞芬太尼在宫腔镜手术中的应用

摘要

目的：比较Narcotrend麻醉/脑电意识监测系统（简称Narcotrend）监测靶控输注（TCI）丙泊酚复合舒芬太尼或TCI瑞芬太尼在宫腔镜手术中的应用效果，为临床麻醉方式和药物选择提供依据。方法将该院2015年6月至2016年6月收治的美国麻醉医师协会分级Ⅰ～Ⅱ级、择期行宫腔镜手术患者120例分为A、B、C组，每组40例。A组采用TCI丙泊酚复合舒芬太尼，B组采用Narcotrend监测TCI丙泊酚复合舒芬太尼，C组采用Narcotrend监测TCI丙泊酚复合TCI瑞芬太尼。记录麻醉前（T1）、诱导后（T2）、扩宫颈时（T3）、定向力恢复后10.0 min （T4）4个时间点患者血压、心率（HR）及Narcotrend监测值。记录丙泊酚总用量、睁眼时间、定向力恢复时间、发生不良反应例数、T4时宫缩痛的疼痛视觉模拟评分（VAS）等。结果 B、C组患者丙泊酚总用量均明显少于A组，睁眼及定向力恢复时间均明显短于A组，术中体动发生率均明显低于A组，差异均有统计学意义（P<0.05）；三组患者T2时收缩压、HR及Narcotrend监测值均明显低于T1时，差异均有统计学意义（P<0.01），T4时均恢复至接近T1时水平；A、B组患者T4时收缩压低于C组，B组患者T4时HR低于C组，差异均有统计学意义（P<0.05）。结论 Narcotrend监测TCI丙泊酚联合舒芬太尼或TCI瑞芬太尼均可为患者提供良好的镇痛、镇静条件，对短时间宫腔镜手术更推荐TCI丙泊酚联合单次应用舒芬太尼。%Objective To compare the effect of Narcotrend anesthesia/electroencephalogram consciousness monitoring system(Narcotrend) monitoring target controlled infusion(TCI) with propofol combined with sufentanyl or TCI with remifentanyl in hysteroscopy operation in order to provide a basis for clinical anesthesia and drug selection. Methods One hundred and twenty ASAⅠorⅡpatients undergoing elective hysteroscopy operation in our hospital from June 2015 to June 2016 were ran-domly divided into the group A,B and C,40 cases in each group. The group A adopted TCI with propofol combined with sufen-tanyl,group B adopted TCI with propofol combined with sufentanyl under Narcotrend monitoring and group C adopted TCI with propofol combined with TCI remifentanyl under Narcotrend monitoring. BP ,HR and Narcotrend monitoring values were recorded at 4 time points of before anesthesia(T1),after induction(T2),dilation of the cervix(T3),at 10.0 min after orientation recovery(T4). The total dose of propofol,time of wake-up and orientation,cases number of adverse reactions occurrence during operation and VAS score of uterine contraction pain at T4 were also recorded. Results The total dose of propofol in the group B and C was sig-nificantly lower than that in the group A,the time of wake-up and orientation recovery was significantly shorter than that in the group A and the occurrence rate of intraoperative body movement was significantly lower than that in the group A ,the difference was statistically significant(P<0.05). SBP,HR,and Narcotrend monitoring values at T2 in the three groups were significantly lower than those at T1,the difference was statistically significant(P<0.01),which at T4 recovered to close to the level at T1. SBP at T4 in the group A and B was lower than that in the group C,HR at T4 in the group B was lower than that in the group C,the difference was statistically significant(P<0.05). Conclusion Narcotrend monitoring TCI with propofol combined with sufentanyl or TCI with remifentanyl all can provide good analgesia and sedation condition for patients. For short time hysteroscopy operation ,TCI with propofol combined with single use of sufentanyl is recommended even more.