CAJ | 학술논문

目的　研究Narcotrend(NT)麻醉深度监测仪用于预防全身麻醉术中知晓的临床效果及安全性.方法择期手术气管插管全身麻醉患者432例,ASA分级Ⅰ～ⅡI级,采用随机数字表法分为观察组和对照组,每组216例,均采用全凭静脉麻醉.观察组根据NT麻醉深度监测仪指导给予麻醉药,对照组根据麻醉医师临床经验判断给予麻醉药.分别观察记录平均动脉压、心率、呼吸频率、脉搏血氧饱和度；记录NT分级、NT指数；记录各药物用量、苏醒时间、拔管时间；记录Ramsay评分；于术后第1、4天各随访1次,了解患者术中感知和记忆情况.结果观察组无术中知晓,对照组怀疑有知晓及肯定知晓各1例.观察组与对照组比较,苏醒时间、拔管时间均降低[(6.0±2.8)　min比(　10.0±4.9)　min,(　12.0±5.5)　min比(19.0±6.9)　min](P＜　0.05)；平均动脉压、心率更为平稳；除咪达唑仑外,其余各药物用量更少(P＜0.05)；意识恢复、气管拔管、出手术室时Ramsay评分更低(P＜0.05).结论　NT麻醉深度监测仪用于全凭静脉麻醉,提高了全身麻醉的安全性,可以在一定程度上降低术中知晓率.
목적　연구Narcotrend(NT)마취심도감측의용우예방전신마취술중지효적림상효과급안전성.방법택기수술기관삽관전신마취환자432례,ASA분급Ⅰ～ⅡI급,채용수궤수자표법분위관찰조화대조조,매조216례,균채용전빙정맥마취.관찰조근거NT마취심도감측의지도급여마취약,대조조근거마취의사림상경험판단급여마취약.분별관찰기록평균동맥압、심솔、호흡빈솔、맥박혈양포화도；기록NT분급、NT지수；기록각약물용량、소성시간、발관시간；기록Ramsay평분；우술후제1、4천각수방1차,료해환자술중감지화기억정황.결과관찰조무술중지효,대조조부의유지효급긍정지효각1례.관찰조여대조조비교,소성시간、발관시간균강저[(6.0±2.8)　min비(　10.0±4.9)　min,(　12.0±5.5)　min비(19.0±6.9)　min](P＜　0.05)；평균동맥압、심솔경위평은；제미체서륜외,기여각약물용량경소(P＜0.05)；의식회복、기관발관、출수술실시Ramsay평분경저(P＜0.05).결론　NT마취심도감측의용우전빙정맥마취,제고료전신마취적안전성,가이재일정정도상강저술중지효솔.
Objective To study the clinical efficacy and safety of Narcotrend (NT) monitor for the prevention of awareness during general anesthesia.Methods Four hundred and thirty-two patients with elective extubation and general anesthesia (ASA Ⅰ-Ⅱ) were divided into observation group and control group with 216 cases each by random digits table.All patients were treated with total intravenous anesthesia.The patients were given anesthetics by NT monitor in observation group and detemined by the clinical experience of anesthesiologists in control group.The mean arterial pressure (MAP),heart rate (HR),respiratory rate(RR),pulse oxygen saturation(SpO2),NT stages (NTS),NT index (NTI),total sedatives,awaking time,extubation time,Ramsay score was recorded.All patients in the postoperative on the first day and the fourth day were followed-up two times to understand the perception and memory in patients undergoing the situation.Results There was no know in operation in observation group,there was 1 case with suspectedknow and 1 case with definite know in control group.Compared with control group,the awaking time and extubation time was decreased in observation group [ ( 6.0 ± 2.8 ) min vs.( 10.0 ± 4.9 ) min,( 12.0 ± 5.5 ) min vs.( 19.0 ± 6.9) min] (P ＜ 0.05 ); MAP and HR was even more stable.In addition to midasolam,the remaining amount of the drug was less (P ＜ 0.05 ).Ramsay score at awaking,extubation and out of the operating room in observation group was lower than that in control group (P ＜ 0.05).Conclusion NT monitor for total intravenous anesthesia increases the safety of general anesthesia,and it can be reduced to some extent,intraoperative awareness.