国际麻醉学与复苏杂志   2013, Issue (8): 7-7
    
高龄患者单侧下肢创伤后手术的麻醉方法比较Narcotrend在老年人喉罩全麻纤支镜检查中的应用
曾蓉, 雷勇静, 刘小彬1()
1.皖南医学院研究生部
Application of Narcotrend for Flexible Fiberoptic Bronchoscopy undergoing Laryngeal Mask Airway Anesthesia in Aged Patients
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摘要：

目的 探讨Narcotrend在老年人喉罩全麻纤支镜检查中应用的可行性、安全性，并寻求其在检查中最适宜的NTI(Narcotrend index, NTI)范围。方法 60例择期行喉罩全麻纤支镜检查的老年患者，采用随机数字表法随机分为3组，每组20例，其中Ⅰ组：NTI(79-65)、Ⅱ组：NTI(64-37)、Ⅲ组：NTI(<37)，监测各时间点的NTI、无创收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、血氧饱和度(SpO2)、心率(HR)和呼末二氧化碳(ETCO2)；记录置喉罩后各组达到靶NTI的时间及丙泊酚的用量；苏醒时间及定向力恢复时间，不良反应等。结果 置喉罩后各组丙泊酚用量I组(2.16±0.31)mg/kg、Ⅱ组(2.78±0.37)mg/kg、Ⅲ组(3.15±0.29)mg/kg，组间差异有统计学意义(P<0.05)。进镜顺利率Ⅰ组85%，其余两组顺利率100%。各时间点Ⅰ、Ⅱ、Ⅲ三组两两比较SBP、DBP、MAP和HR波动明显，差异有统计学意义(P<0.05)，且Ⅲ组术中有2例低血压及心动过缓的表现。同时在苏醒时间及定向力恢复时间上Ⅲ组(9.4±3.1 、10.8±4.2)较Ⅱ组(6.2±2.4、7.5±2.5)明显延长(P<0.05)。结论 应用Narcotrend监测老年患者在术中的麻醉镇静深度和调控丙泊酚的用量是安全、平稳、有效的,对老年人喉罩全麻纤支镜检查的适宜NTI在D(64-37)。
关键词： Narcotrend指数； 喉罩； 老年患者； 纤支镜检查
Abstract:

Objective To investigate the feasibility and safety of Narcotrend for flexible fiberoptic bronchoscopy (FOB) undergoing laryngeal mask airway (LMA) anesthesia in the aged patients and to explore the optimal NTI in the examination. Methods Sixty aged patients were assigned into three groups according to randomly digital table:(Ⅰ)NTI(79-65),(Ⅱ)NTI(64-37),(Ⅲ)NTI(<37).Integral dose of propofol (after inserting LMA), awakening and orientation recovery time and relatively complications were recorded.NTI、SBP、DBP、MAP、SpO2 and HR were compared in three groups during different points. Results The dose of propofol (after inserting LMA) were (2.16±0.31)mg/kg,(2.78±0.37)mg/kg,(3.15±0.29)mg/kg in three groups respectively.The successful rate of FOB insertion were 85%,100%,100% respectively. SBP、DBP、MAP and HR were fluctuated in varying degrees during different points with a significant difference between each 2 groups(P<0.05).In the third group hypotension were found during intraopration, awakening(9.4±3.1) and orientation recovery time(10.8±4.2) were longer than other two groups(6.2±2.4、7.5±2.5) (P<0.05). Conclusion It is safe, reliable and feasible to regulate the sedative depth and the dosage of propofol infusion with Narcotrend monitor. The optimal Narcotrend index in the aged patients undergoing FOB with LMA anesthesia is from 37 to 64.
Key words: Narcotrend index; laryngeal mask; the aged patients; flexible fiberoptic bronchoscopy