中国现代医药杂志
中國現代醫藥雜誌
중국현대의약잡지
Modern Medicine Journal of China
2015年
11期
32-35
,共4页
黄锡强%李斌飞%熊浩岚%韦凯斌
黃錫彊%李斌飛%熊浩嵐%韋凱斌
황석강%리빈비%웅호람%위개빈
鼻内窥镜手术%控制性降压%麻醉深度%术中知晓
鼻內窺鏡手術%控製性降壓%痳醉深度%術中知曉
비내규경수술%공제성강압%마취심도%술중지효
Nasal endoscopic surgery%Controlled hypotension%Depth of anesthesia%Intraoperative awareness
目的： Narcotrend 麻醉深度监测（NT）下在鼻内窥镜手术中行控制性降压，观察其可行性及安全性。方法选取60例行鼻内窥镜手术患者，随机平均分成两组，均接受NT 监测，术中行控制性降压。 A 组根据NT 控制麻醉深度，维持NT 分级在D2～E1，NT 值在46～20，B 组根据麻醉医师经验控制麻醉深度。分别记录两组患者设定时间点的平均动脉压、心率、NT 值（B 组为术毕回顾），记录两组患者麻醉药物及血管活性药物用量、手术时间、拔管时间、苏醒时间、出血量及Fromme 评分，随访术中知晓情况。结果两组患者平均动脉压比较差异无统计学意义（P>0.05），对应时间点A 组心率明显快于B 组（P<0.05），B 组NT 值明显低于A 组（P<0.05），A 组使用七氟醚明显少于B 组，硝酸甘油和美托洛尔明显多于B 组（P<0.05），A 组术毕至拔管时间较B 组明显缩短（P<0.05）。B 组发现1例可疑术中知晓。结论 Narcotrend 麻醉深度监测下在鼻内窥镜手术中行控制性降压，能减少出血，准确控制麻醉深度，避免麻醉过深或过浅，缩短术后复苏时间，减少麻醉药物浪费，提高了控制性降压的安全性。
目的： Narcotrend 痳醉深度鑑測（NT）下在鼻內窺鏡手術中行控製性降壓，觀察其可行性及安全性。方法選取60例行鼻內窺鏡手術患者，隨機平均分成兩組，均接受NT 鑑測，術中行控製性降壓。 A 組根據NT 控製痳醉深度，維持NT 分級在D2～E1，NT 值在46～20，B 組根據痳醉醫師經驗控製痳醉深度。分彆記錄兩組患者設定時間點的平均動脈壓、心率、NT 值（B 組為術畢迴顧），記錄兩組患者痳醉藥物及血管活性藥物用量、手術時間、拔管時間、囌醒時間、齣血量及Fromme 評分，隨訪術中知曉情況。結果兩組患者平均動脈壓比較差異無統計學意義（P>0.05），對應時間點A 組心率明顯快于B 組（P<0.05），B 組NT 值明顯低于A 組（P<0.05），A 組使用七氟醚明顯少于B 組，硝痠甘油和美託洛爾明顯多于B 組（P<0.05），A 組術畢至拔管時間較B 組明顯縮短（P<0.05）。B 組髮現1例可疑術中知曉。結論 Narcotrend 痳醉深度鑑測下在鼻內窺鏡手術中行控製性降壓，能減少齣血，準確控製痳醉深度，避免痳醉過深或過淺，縮短術後複囌時間，減少痳醉藥物浪費，提高瞭控製性降壓的安全性。
목적： Narcotrend 마취심도감측（NT）하재비내규경수술중행공제성강압，관찰기가행성급안전성。방법선취60례행비내규경수술환자，수궤평균분성량조，균접수NT 감측，술중행공제성강압。 A 조근거NT 공제마취심도，유지NT 분급재D2～E1，NT 치재46～20，B 조근거마취의사경험공제마취심도。분별기록량조환자설정시간점적평균동맥압、심솔、NT 치（B 조위술필회고），기록량조환자마취약물급혈관활성약물용량、수술시간、발관시간、소성시간、출혈량급Fromme 평분，수방술중지효정황。결과량조환자평균동맥압비교차이무통계학의의（P>0.05），대응시간점A 조심솔명현쾌우B 조（P<0.05），B 조NT 치명현저우A 조（P<0.05），A 조사용칠불미명현소우B 조，초산감유화미탁락이명현다우B 조（P<0.05），A 조술필지발관시간교B 조명현축단（P<0.05）。B 조발현1례가의술중지효。결론 Narcotrend 마취심도감측하재비내규경수술중행공제성강압，능감소출혈，준학공제마취심도，피면마취과심혹과천，축단술후복소시간，감소마취약물낭비，제고료공제성강압적안전성。
Objective To observe the feasibility and safety of the application by using Narcotrend electroencephalogram consciousness monitoring (NT) to controlled hypotension in patients with nasal endoscopic surgery. Methods A total of 60 patients treated with controlled hypotension in nasal endoscopic surgery were randomly divided into two groups, and received the NT monitoring. In group A, the depth of anesthesia was controlled according to NT, to maintain the NT in the level of D2~E1, NT value in 46~20. In group B, the depth of anesthesia was controlled according to the experience from anesthetist. The mean arterial pressure, heart rate, NT value (group B were post-operative reviewed), anesthetic dosage, vascular active drug dosage, operation time, extubation time, awakening time, blood loss and Fromme score and intraoperative awareness were recorded. Re-sults There was no significant difference between the two groups in the mean arterial pressure (P>0.05). The heart rate of pa-tients in group A was significantly faster than group B (P<0.05), while the NT value of patients in group B was significantly lower than group A (P<0.05). In terms of the use of sevoflurane, group A was significantly less than group B (P<0.05). The use of nitroglycerin and metoprolol in group A was significantly more than group B (P<0.05). The extubation time of group A was significantly shorter than group B (P<0.05). There was one case of suspicious intraoperative awareness in group B. Conclusion Controlled hypotension under the application of Narcotrend monitoring in nasal endoscopic surgery can reduce the blood loss, accurately control the depth of anesthesia, avoid anesthesia too deep or too shallow, shorten the postoperative recovery time, re-duce the waste of narcotic drugs, and improve the security of controlled hypotension.
