国际麻醉学与复苏杂志   2013, Issue (10): 1-1
    
麻醉深度对老年肠癌患者术中血流动力学和麻醉复苏的影响
康茵, 邓龙姣, 赵国栋, 王刚, 李海风, 田可耘1()
1.广东省人民医院(广东省医学科学院)
Effects of different depths of anesthesia on hemodynamic stability and anesthesia recovery in the elderly undergoing elective laparoscopic surgery for colorectal cancer
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摘要:

目的 探讨Narcotrend监测下3种不同麻醉深度对老年肠癌根治手术患者血流动力学和麻醉复苏的影响。 方法 全身麻醉下行腹腔镜肠癌根治术的老年患者150例,60岁~92岁,美国麻醉医师协会(ASA)分级Ⅰ~Ⅲ级,根据随机数字表法将患者随机均分为3组(每组50例):A组[维持麻醉深度Narcotrend指数(narcotrend index, NI)在D0]、B组(NI维持在D2)和C组(NI维持在E1)。术中根据Narcotrend监测结果调整麻醉用药,使各组麻醉深度维持在预设定目标水平。观察并记录患者不同时点血流动力学变化、麻醉药用量、麻醉复苏情况及副作用。 结果 A组患者心率(heart rate, HR)和平均动脉压(mean artery pressure, MAP)在气管插管后即刻、气腹后2 min、手术结束和拔管时明显增加(P<0.05),3组患者的MAP在麻醉诱导后和气腹前均比基础值明显降低(P<0.05或P<0.01);C组患者MAP在麻醉诱导后和气腹前明显低于A组和B组(P<0.05)。A组患者高血压的发生率为31.3%(15/48),明显高于B组的14.6%(7/48)和C组的12.2%(6/49)(P<0.05);C组低血压的发生率为40.8%(20/49),明显高于A组的12.5%(6/48)和B组的18.8%(9/48)(P<0.01)。C组丙泊酚用量明显多于A组和B组[分别为(1 136±378)、(1 217±366)、(1 637±423) mg](P<0.05),C组睁眼时间和拔管时间[(14.8±1.3)、(19.2±4.8) min]较A组[(7.2±1.4)、(10.0±3.3) min]和B组[(8.1±1.1)、(11.8±2.6) min]明显延长(P<0.01)。 结论 老年肠癌患者术中麻醉深度维持在D2最为理想,该麻醉深度不增加麻醉用药和麻醉复苏时间,且更有利于维持血流动力学的稳定。

关键词: 【关键词】麻醉深度;Narcotrend;老年;监测
Abstract:

Objective To investigate the effects of three different depths of anesthesia on hemodynamic changes and anesthesia recovery undergoing elective surgery in the elderly. Methods 150 ASA Ⅰ?蛳Ⅲ patients>60 years undergoing elective laparoscopic surgery for colorectal cancer with general anesthesia were randomized into 3 groups of group A [anesthesia depth maintained with the target of narcotrend index(NI)at D0 level], group B (NI at D2 level) and group C (NI at E1 level). Anesthetics (propofol and remifentanil) were adjusted according to the narcotrend monitoring results to keep the depth of anesthesia in the preset target level. The hemodynamic changes at different time points, anesthetic consumption, the patients' condition during anesthesia recovery and adverse reaction were recorded. Results The patients' mean artery pressure(MAP) and heart rate(HR) in group A were markedly increased after tracheal intubation, 2 min after artificial pneumoperitoneum, end of the surgery and during extubation(P<0.05). The patients' MAP of the three groups were all significantly decreased 2 min after the anesthesia induction and 2 min before artificial pneumoperitoneum (P<0.05 or P<0.01). The patients' MAP of group C was significantly lower than that of group A and group B 2 min after anesthesia induction and 2 min before artificial pneumoperitoneum(P<0.05). The incidence of hypertension was 31.3% in group A, which was significantly higher comparing to group B(14.6%) and group C(12.2%)(P<0.05). And the incidence of hypotension was apparently higher in group C(40.8%) than that of group A(12.5%) and group B(18.8%)(P<0.01). The propofol consumption of group C[(1 637±423) mg] was much more than that of group A and group B[(1 136±378) mg and(1 217±366) mg respectively] (P<0.05), and the recovery times(eye opening time and extubation time) were significantly longer ingroup C [(14.8±1.3),(19.2±4.8) min] comparing to group A[(7.2±1.4),(10.0±3.3) min]and group C [(8.1±1.1),(11.8±2.6) min](P<0.01). Conclusions It's best to maintain the depth of anesthesia at the target of NI at D2 level in the elderly undergoing laparoscopic surgery for colorectal cancer, which is more helpful to gain hemodynamic stability without increasing anesthetic consumption and delayed recovery.

Key words: 【Key words】 Depth of anesthesia; Narcotrend; elderly; monitoring