Narcotrend麻醉深度监测下控制性降压在鼻内窥镜手术中的应用

摘要

Objective To observe the feasibility and safety of the application by using Narcotrend electroencephalogram consciousness monitoring (NT) to controlled hypotension in patients with nasal endoscopic surgery. Methods A total of 60 patients treated with controlled hypotension in nasal endoscopic surgery were randomly divided into two groups, and received the NT monitoring. In group A, the depth of anesthesia was controlled according to NT, to maintain the NT in the level of D2~E1, NT value in 46~20. In group B, the depth of anesthesia was controlled according to the experience from anesthetist. The mean arterial pressure, heart rate, NT value (group B were post-operative reviewed), anesthetic dosage, vascular active drug dosage, operation time, extubation time, awakening time, blood loss and Fromme score and intraoperative awareness were recorded. Re-sults There was no significant difference between the two groups in the mean arterial pressure (P>0.05). The heart rate of pa-tients in group A was significantly faster than group B (P<0.05), while the NT value of patients in group B was significantly lower than group A (P<0.05). In terms of the use of sevoflurane, group A was significantly less than group B (P<0.05). The use of nitroglycerin and metoprolol in group A was significantly more than group B (P<0.05). The extubation time of group A was significantly shorter than group B (P<0.05). There was one case of suspicious intraoperative awareness in group B. Conclusion Controlled hypotension under the application of Narcotrend monitoring in nasal endoscopic surgery can reduce the blood loss, accurately control the depth of anesthesia, avoid anesthesia too deep or too shallow, shorten the postoperative recovery time, re-duce the waste of narcotic drugs, and improve the security of controlled hypotension.%目的： Narcotrend 麻醉深度监测（NT）下在鼻内窥镜手术中行控制性降压，观察其可行性及安全性。方法选取60例行鼻内窥镜手术患者，随机平均分成两组，均接受NT 监测，术中行控制性降压。 A 组根据NT 控制麻醉深度，维持NT 分级在D2～E1，NT 值在46～20，B 组根据麻醉医师经验控制麻醉深度。分别记录两组患者设定时间点的平均动脉压、心率、NT 值（B 组为术毕回顾），记录两组患者麻醉药物及血管活性药物用量、手术时间、拔管时间、苏醒时间、出血量及Fromme 评分，随访术中知晓情况。结果两组患者平均动脉压比较差异无统计学意义（P>0.05），对应时间点A 组心率明显快于B 组（P<0.05），B 组NT 值明显低于A 组（P<0.05），A 组使用七氟醚明显少于B 组，硝酸甘油和美托洛尔明显多于B 组（P<0.05），A 组术毕至拔管时间较B 组明显缩短（P<0.05）。B 组发现1例可疑术中知晓。结论 Narcotrend 麻醉深度监测下在鼻内窥镜手术中行控制性降压，能减少出血，准确控制麻醉深度，避免麻醉过深或过浅，缩短术后复苏时间，减少麻醉药物浪费，提高了控制性降压的安全性。