体位对静脉全身麻醉患者Narcotrend指数的影响

摘要

Objective:To prospectively evaluate the effects of body position to the narcotrend index during intravenous anaesthesia.Method: 45 elective surgery patients aged from 20 to 60 years were selected in our hospital from July 2013 to December 2013,whom were 24 males and 21 females,with the BMI 17-23 kg/m2 and ASAI-Ⅱ level, the intravenous general anesthesia were underwent. Propofol and remifentanil anesthesia protocol was introduced and maintained with Target-controlled infusion(TCI) in supine position.5 min after reaching steady-state target concentration,the patients were changed in Trendelenburg position(30 degrees) and maintained about 10 min;10 min later,the position into anti-trendelenburg position were changed (30 degrees),also maintained about 10 min. Narcotrend Index (NI), mean arterial pressure (MAP), heart rate (HR), end-tidal carbon dioxide partial pressure (PETCO2) were recorded separately at the time points of before trendelenburg position(T0),immediately(T1),1 min (T2) later, 3 min(T3) later,5 min(T4) later and 10 min(T5) later after in Trendelenburg position and anti-trendelenburg position.Result:Compared the parameters in supine position(T0),patients’ MAP in Trendelenburg position at the time point of T2-5 increased,also the NI at the time piont of T2-4 ,the difference was statistically significant (P<0.05).While, they were decreased in anti-trendelenburg position..The MAP at the point of T2-5,NI at the point of T2-4 were significantly lower in Trendelenburg position than in anti-trendelenburg position,the difference was statistically significant (P<0.01).Conclusion:Patients’ body position during intravenous anaesthesia can affect the Narcotrend index, of which will affect the anesthesiologists to judgment patients’ anesthesia depth.%目的：观察体位对Narcotrend指数的影响。方法：选择2013年7-12月择期静脉全身麻醉手术患者45例，年龄20~60岁，男24例，女21例，体重指数17~23 kg/m2，ASAⅠ~Ⅱ级。平卧位靶控输注（TCI）异丙酚和瑞芬太尼麻醉诱导并维持麻醉，达到稳态靶浓度后5 min时，将患者置于头低脚高位（300），维持约10 min；将患者调至平卧位10 min后，再将患者置于头高脚低高位（300），维持约10 min。分别记录头低脚高位前（T0）、头低脚高位即刻（T1）、1 min（T2）、3 min（T3）、5 min（T4）和10 min（T5）以及头高脚低位即刻（T1）、1 min（T2）、3 min（T3）、5 min（T4）和10 min（T5）各时点的Narcotrend指数（NI）、平均动脉压（MAP）、心率（HR）、呼气末二氧化碳分压（PETCO2）。结果：与平卧位（T0）比较，患者头低脚高位时T2~5 MAP、T2~4 NI升高，头高脚低位时T2~5 MAP、T2~4 NI降低，差异有统计学意义（P<0.05）；与头低脚高位相同时点比较，患者头高脚低位时T2~5 MAP、T2~4 NI明显降低，差异有统计学意义（P<0.01）。结论：体位可影响静脉全身麻醉患者Narcotrend指数，影响麻醉医师对患者麻醉深度的判断。