中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
3期
8-11
,共4页
卢增停%王立勋%马钧阳%钟梅英%杨纲华%何绮桃%曾丽蓉%林霭婷
盧增停%王立勛%馬鈞暘%鐘梅英%楊綱華%何綺桃%曾麗蓉%林靄婷
로증정%왕립훈%마균양%종매영%양강화%하기도%증려용%림애정
腹腔镜%甲状腺切除术%Narcotrend监测%麻醉深度%快通道麻醉
腹腔鏡%甲狀腺切除術%Narcotrend鑑測%痳醉深度%快通道痳醉
복강경%갑상선절제술%Narcotrend감측%마취심도%쾌통도마취
Laparoscopes%Thyroidectomy%Narcotrend monitoring%Depth of anesthesia%Fast-track anesthesia
目的 观察Narcotrend监测在腔镜甲状腺切除术快通道麻醉中应用的效果,评价Narcotrend监测在快通道麻醉中应用的可行性.方法 择期行腔镜甲状腺切除术患者100例,按随机数字表法分为N组(Narcotrend监测组)和C组(对照组),每组50例.两组均以丙泊酚、瑞芬太尼、阿曲库铵行麻醉诱导和麻醉维持并行Narcotrend监测,N组和C组术中分别根据Narcotrend指数(NI)或临床体征和临床经验调整丙泊酚和瑞芬太尼用量.两组术后进行Steward评分,以术毕10 min内Steward评分≥4分拔除喉罩者为快通道麻醉实施成功.记录两组麻醉诱导前(T1)、喉罩置入(T2)、切皮(T3)、充气后10 min (T4)、充气后30 min (T5)、手术结束时(T6)、拔除喉罩前(T7)、拔除喉罩后5 min(T8)的NI.记录麻醉药用量、苏醒时间、拔除喉罩时间、快通道麻醉成功情况、术中知晓情况、术后恶心呕吐、术后躁动发生情况.结果 N组NI高于C组(F=192.363,P=0.000),组间与时间点存在交互作用(F=48.254,P=0.000);N组T3、T4、T5和T6NI均明显高于C组(58.2±5.3比44.6±6.7、55.3±6.8比39.5±7.1、54.6±6.6比36.3±6.7、65.2±5.5比56.3±7.4),差异有统计学意义(P＜0.01).两组瑞芬太尼、阿曲库铵用量比较差异均无统计学意义(P＞0.05);N组丙泊酚用量明显小于C组[(462±86)mg比(635±120) mg],苏醒时间和拔除喉罩时间均明显短于C组[(5.2±1.3)min比(8.9±2.2) min、(7.3±2.5) min比(12.5±3.1) min],快通道麻醉成功率明显高于C组[84.0％(42/50)比44.0％(22/50)],术后恶心呕吐发生率低于C组[4.0％(2/50)比16.0％(8/50)],差异有统计学意义(P＜0.01或＜0.05).两组术中知晓(N组无术中知晓,C组有3例)、术后躁动发生率比较差异均无统计学意义(P＞0.05).结论 Narcotrend监测用于腔镜甲状腺切除术快通道麻醉,有利于对麻醉深度的调控,避免麻醉过深或过浅,防止术中知晓;同时可以减少全身麻醉药用量,促进患者术后尽早复苏,提高快通道麻醉成功率,降低术后恶心呕吐等不良反应的发生率.
目的 觀察Narcotrend鑑測在腔鏡甲狀腺切除術快通道痳醉中應用的效果,評價Narcotrend鑑測在快通道痳醉中應用的可行性.方法 擇期行腔鏡甲狀腺切除術患者100例,按隨機數字錶法分為N組(Narcotrend鑑測組)和C組(對照組),每組50例.兩組均以丙泊酚、瑞芬太尼、阿麯庫銨行痳醉誘導和痳醉維持併行Narcotrend鑑測,N組和C組術中分彆根據Narcotrend指數(NI)或臨床體徵和臨床經驗調整丙泊酚和瑞芬太尼用量.兩組術後進行Steward評分,以術畢10 min內Steward評分≥4分拔除喉罩者為快通道痳醉實施成功.記錄兩組痳醉誘導前(T1)、喉罩置入(T2)、切皮(T3)、充氣後10 min (T4)、充氣後30 min (T5)、手術結束時(T6)、拔除喉罩前(T7)、拔除喉罩後5 min(T8)的NI.記錄痳醉藥用量、囌醒時間、拔除喉罩時間、快通道痳醉成功情況、術中知曉情況、術後噁心嘔吐、術後躁動髮生情況.結果 N組NI高于C組(F=192.363,P=0.000),組間與時間點存在交互作用(F=48.254,P=0.000);N組T3、T4、T5和T6NI均明顯高于C組(58.2±5.3比44.6±6.7、55.3±6.8比39.5±7.1、54.6±6.6比36.3±6.7、65.2±5.5比56.3±7.4),差異有統計學意義(P＜0.01).兩組瑞芬太尼、阿麯庫銨用量比較差異均無統計學意義(P＞0.05);N組丙泊酚用量明顯小于C組[(462±86)mg比(635±120) mg],囌醒時間和拔除喉罩時間均明顯短于C組[(5.2±1.3)min比(8.9±2.2) min、(7.3±2.5) min比(12.5±3.1) min],快通道痳醉成功率明顯高于C組[84.0％(42/50)比44.0％(22/50)],術後噁心嘔吐髮生率低于C組[4.0％(2/50)比16.0％(8/50)],差異有統計學意義(P＜0.01或＜0.05).兩組術中知曉(N組無術中知曉,C組有3例)、術後躁動髮生率比較差異均無統計學意義(P＞0.05).結論 Narcotrend鑑測用于腔鏡甲狀腺切除術快通道痳醉,有利于對痳醉深度的調控,避免痳醉過深或過淺,防止術中知曉;同時可以減少全身痳醉藥用量,促進患者術後儘早複囌,提高快通道痳醉成功率,降低術後噁心嘔吐等不良反應的髮生率.
목적 관찰Narcotrend감측재강경갑상선절제술쾌통도마취중응용적효과,평개Narcotrend감측재쾌통도마취중응용적가행성.방법 택기행강경갑상선절제술환자100례,안수궤수자표법분위N조(Narcotrend감측조)화C조(대조조),매조50례.량조균이병박분、서분태니、아곡고안행마취유도화마취유지병행Narcotrend감측,N조화C조술중분별근거Narcotrend지수(NI)혹림상체정화림상경험조정병박분화서분태니용량.량조술후진행Steward평분,이술필10 min내Steward평분≥4분발제후조자위쾌통도마취실시성공.기록량조마취유도전(T1)、후조치입(T2)、절피(T3)、충기후10 min (T4)、충기후30 min (T5)、수술결속시(T6)、발제후조전(T7)、발제후조후5 min(T8)적NI.기록마취약용량、소성시간、발제후조시간、쾌통도마취성공정황、술중지효정황、술후악심구토、술후조동발생정황.결과 N조NI고우C조(F=192.363,P=0.000),조간여시간점존재교호작용(F=48.254,P=0.000);N조T3、T4、T5화T6NI균명현고우C조(58.2±5.3비44.6±6.7、55.3±6.8비39.5±7.1、54.6±6.6비36.3±6.7、65.2±5.5비56.3±7.4),차이유통계학의의(P＜0.01).량조서분태니、아곡고안용량비교차이균무통계학의의(P＞0.05);N조병박분용량명현소우C조[(462±86)mg비(635±120) mg],소성시간화발제후조시간균명현단우C조[(5.2±1.3)min비(8.9±2.2) min、(7.3±2.5) min비(12.5±3.1) min],쾌통도마취성공솔명현고우C조[84.0％(42/50)비44.0％(22/50)],술후악심구토발생솔저우C조[4.0％(2/50)비16.0％(8/50)],차이유통계학의의(P＜0.01혹＜0.05).량조술중지효(N조무술중지효,C조유3례)、술후조동발생솔비교차이균무통계학의의(P＞0.05).결론 Narcotrend감측용우강경갑상선절제술쾌통도마취,유리우대마취심도적조공,피면마취과심혹과천,방지술중지효;동시가이감소전신마취약용량,촉진환자술후진조복소,제고쾌통도마취성공솔,강저술후악심구토등불량반응적발생솔.
Objective To investigate the effect of Narcotrend monitoring in fast-track anesthesia for endoscopic thyroidectomy,and evaluate the feasibility of application of Narcotrend monitoring in fast-track anesthesia.Methods One hundred patients who undergoing endoscopic thyroidectomy were divided into group N (Narcotrend monitoring group,50 cases) and group C (control group,50 cases) by random digits table method.All patients were induced and maintained with propofol,remifentanil and atracurium while monitored by Narcotrend,propofol and remifentanil infusion rate were adjusted in two groups according to Narcotrend index (NI) and the clinical standard practice during operation.Steward score was assessed postoperative to test for success of fast-track anesthesia (Steward score≥4 points within 10 min).NI in two groups were recorded at time points:before induction of anesthesia (T1),at laryngeal mask airway(LMA) insertion(T2),skin incision (T3),10 min(T4) and 30 min(T5) after CO2 sufflation,at the end of operation (T6),just before LMA removal (T7),5 min after LMA removal (Ts).Anesthetic dosage,recovery time,LMA removal time,intraoperative awareness,postoperative nausea and vomiting (PONV),postoperative agitation were recorded and the success rate of fast-track anesthesia of each group was calculated.Results NI of group N was higher than that of group C (F =192.363,P =0.000),and there was interaction between groups and time points (F =48.254,P =0.000).NI of group N was significantly higher than that of group C at T3,T4,T5,T6 (58.2 ± 5.3 vs.44.6 ± 6.7,55.3 ± 6.8 vs.39.5 ± 7.1,54.6 ± 6.6 vs.36.3 ± 6.7 and 65.2 ± 5.5 vs.56.3 ±7.4),and there were statistical differences (P ＜0.01),but there was no statistical differences between two groups at T1,T2,T7,T8 (P ＞ 0.05).There was no statistical difference in amount of remifentanil and atracurium between two groups (P ＞ 0.05).The amount of propofol,recovery time and LMA removal time of group N were significantly less than those of group C [(462 ± 86) mg vs.(635 ± 120) mg,(5.2 ± 1.3) min vs.(8.9 ± 2.2) min and (7.3 ± 2.5) min vs.(12.5 ± 3.1) min,P ＜ 0.01].The success rate of fasttrack anesthesia of group N was significantly higher than that of group C [84.0％(42/50) vs.44.0％(22/50),P ＜ 0.01].The rate of PONV of group N was lower than that of group C [4.0％(2/50) vs.16.0％ (8/50)],and there was significant difference (P ＜ 0.05).There was none of intraoperative awareness in group N while 3 cases in group C,but with no statitical difference between two groups (P＞ 0.05).There was no statistical difference in postoperative agitation between two groups(P ＞ 0.05).Conclusions Narcotrend monitoring in fast-track anesthesia for endoscopic thyroidectomy is conductive to optimizing depth of anesthesia,may avoid deep or light anesthesia and prevent intraoperative awareness; at the same time,it can reduce the anesthetic dosage,speed up recovery and increase the success rate of fast-track anesthesia,also reduce the rate of PONV.
