摘要
目的:探讨Narcotrend监测在腹腔镜下胃肠道恶性肿瘤切除手术中的应用价值。方法:选择择期行胃肠道恶性肿瘤切除患者60名,随机分入N组(Narcotrend监测组)和C组(常规组),每组30例。术中根据NI值及临床体征和临床经验调整丙泊酚和瑞芬太尼用量。分别记录两组诱导前(T0)、诱导后(T1)、气腹后5min(T2)、气腹后30min(T3)、肿瘤切完时(T4)、停止输注丙泊酚时(T5)、清醒拔管后(T6)、听从指令(T7)不同时间点的SBP、DBP、HR、RPP与丙泊酚效应室浓度(Ceo Prop),记录N组相应时间点的Narcotrend指数(NI);记录两组患者术毕后苏醒时间、定向力恢复时间、自主呼吸恢复时间和清醒拔管时间,不良反应、随访及术后术中知晓情况并进行视觉模拟评分(VAS评分)。结果:与T0时比较,T2、T3时N组与C组SBP、DBP、HR、RPP均显著增高(P<0.05);N组NI值随着丙泊酚效应室浓度的增加而降低,呈负相关(r=-0.784,P<0.05)。N组患者丙泊酚及瑞芬太尼使用量均少于C组患者(P<0.05),术后N组患者苏醒时间、自主呼吸恢复时间、定向力恢复时间及清醒拔管时间较C组均明显缩短,差别具有显著性(P<0.05)。N组术中发生不良反应的比例远低于C组,差别具有显著性(P<0.05)。两组患者术后一天VAS评分比较差别无显著性(P>0.05),均未出现术中知晓。结论:Narcotrend监测用于胃肠道恶性肿瘤切除术能精确调节手术麻醉深度,有效监测患者的意识状态和麻醉深度,减少麻醉用药,缩短苏醒时间,有利于提高麻醉质量和安全系数,值得临床推广使用。
Objective: To investigate the value of Narcotrend anesthesia monitoring on gastrointestinal cancer laparoscopic resection. Methods: All 60 patients with gastrointestinal carcinoma were selected and randomly divided into Narcotrend group（ N group） and regular group（ C group）,each group 30 cases. The N group were adopted Narcotrend monitoring system in surgery whereas the C group were not adopted Narcotrend monitoring system. The indicator value of SBP,DBP,HR,the numerical value of Narcotrend and dosage of anesthetics were recorded at the following time points respectively: Instantly before anesthesia induction（ T0）,immediately after anesthesia induction（ T1）,5minutes after CO2pneumoperitoneum（ T2）,30 minutes after CO2pneumoperitoneum（ T3）,immediately after operation（ T4）,stop diprifusor（ T5）,instantly after conscious tracheal extubation（ T6） and follow requirement（ T7） respectively. After the operation,the recovery times of autonomous respiration,recovery time of consciousness,recovery time of orientation,time of conscious tracheal extubation,visual analogue scale（ VAS） and the incidence of intraoperative awareness were recorded. Results: There was a statistical significance between the two groups in T2- T3 compared to T0（ P < 0. 05）. The value of NI decreased obviously following the increase of effect- site concentration of propofol,there was a negative correlation between NI and concentration of propofol. The dosage of propofol in N group was significantly less than C group（ P < 0. 05）. The recovery time of autonomous respiration,recovery time of consciousness,recovery time of orientation,time for conscious tracheal extubation in N group were all shorter than those in C group（ P < 0. 05）. The difference of VAS between the two groups was not statistically significant（ P > 0. 05）. No case of intraoperative awareness was found in the two groups. Conclusion: Narcotrend monitoring system can effectively monitor the patient’s state of consciousness and the depth of anesthesia,keeps smooth and steady haemodynamics and the dosage of anesthetic drugs more accurate,as well as improves the quality of the anesthetic revival.
出处
《现代肿瘤医学》
CAS
2016年第12期1972-1976,共5页
Journal of Modern Oncology
