CAJ | 학술논문

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l2.2％(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.
목적 탐토Narcotrend감측하3충불동마취심도대노년장암근치수술환자혈류동역학화마취복소적영향.방법 전신마취하행복강경장암근치술적노년환자150례,60세～92세,미국마취의사협회(ASA)분급Ⅰ～Ⅲ급,근거수궤수자표법장환자수궤균분위3조(매조50례):A조[유지마취심도Narcotrend지수(narcotrend index,NI)재D0]、B조(NI유지재D2)화C조(NI유지재E1).술중근거Narcotrend감측결과조정마취용약,사각조마취심도유지재예설정목표수평.관찰병기록환자불동시점혈류동역학변화、마취약용량、마취복소정황급부작용. 결과 A조환자심솔(heart rate,HR)화평균동맥압(mean artery pressure,MAP)재기관삽관후즉각、기복후2 min、수술결속화발관시명현증가(P＜0.05),3조환자적MAP재마취유도후화기복전균비기출치명현강저(P＜0.05혹P＜0.01)；C조환자MAP재마취유도후화기복전명현저우A조화B조(P＜0.05).A조환자고혈압적발생솔위31.3％(15/48),명현고우B조적14.6％(7/48)화C조적l2.2％(6/49)(P＜0.05)；C조저혈압적발생솔위40.8％(20/49),명현고우A조적12.5％(6/48)화B조적18.8％(9/48) (P＜0.01).C조병박분용량명현다우A조화B조[분별위(1 136±378)、(1 217±366)、(1 637±423) mg](P＜0.05),C조정안시간화발관시간[(14.8±1.3)、(19.2±4.8) min]교A조[(7.2±1.4)、(10.0±3.3) min]화B조[(8.1±1.1)、(11.8±2.6) min]명현연장(P＜0.01). 결론 노년장암환자술중마취심도유지재D2최위이상,해마취심도불증가마취용약화마취복소시간,차경유리우유지혈류동역학적은정.
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-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 Do 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 in group 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.