體位因素對全憑靜脈麻醉老年患者Narcotrend指數(shù)的影響

黃卓梅+高曉楓+汪飛

【摘要】 目的：探討在麻醉深度不變的情況下，體位因素對全麻老年患者Narcotrend指數(shù)的影響。方法：擇期全憑靜脈麻醉手術(shù)患者30例，年齡60～80歲，ASAⅡ～Ⅲ級，體重指數(shù)18～24 kg/m2。麻醉誘導(dǎo)靜脈注射舒芬太尼、丙泊酚、順阿曲庫胺，Narcotrend指數(shù)值40～45時行氣管插管全憑靜脈麻醉，麻醉維持予以血漿靶控輸注丙泊酚和瑞芬太尼，達到穩(wěn)態(tài)靶濃度后10 min時將患者調(diào)至頭低腳高位（30°），記錄頭低體位前（T0）、頭低體位即刻（T1）、1 min（T2）、3 min（T3）、5 min（T4）和10 min（T5）時HR、MAP、Narcotrend指數(shù)值；將患者調(diào)至平臥位，10 min后再調(diào)至頭高腳低位（30°），記錄頭高體位前（T0）、頭高體位即刻（T1）、1 min（T2）、3 min（T3）、5 min（T4）和10 min（T5）時HR、MAP、Narcotrend指數(shù)值。比較同一體位不同時點、兩種體位同一時間點的HR、MAP、Narcotrend指數(shù)。結(jié)果：患者頭低腳高位，T2、T3、T4時MAP、Narcotrend指數(shù)分別與T0時比較均升高，差異均有統(tǒng)計學(xué)意義（P<0.05）；患者頭高腳低位，T2、T3、T4時MAP、Narcotrend指數(shù)分別與T0時比較均下降，差異均有統(tǒng)計學(xué)意義（P<0.05）；T2、T3、T4三個相同時間點，頭高腳低位患者的MAP、Narcotrend指數(shù)均低于頭低腳高位患者，比較差異均有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論：體位改變對全憑靜脈麻醉老年患者Narcotrend指數(shù)可引起一過性改變，影響麻醉醫(yī)師對患者麻醉深度的判斷。

【關(guān)鍵詞】 Narcotrend腦電監(jiān)測； 全憑靜脈麻醉； 麻醉深度； 體位； 老年人

【Abstract】 Objective：To investigate the effects of posture on the Narcotrend index in elderly patients undergoing total intravenous anaesthesia.Method：30 patients with elective total intravenous anesthesia were selected，aged 60-80 years，ASA grade Ⅱ-Ⅲ，body mass index 18-24 kg/m2.Anesthesia was induced by intravenous injection of sufentanil，propofol，cisatracurium besylate.Narcotrend index of 40 to 45 when tracheal intubation general anesthesia， anesthesia to maintain plasma target-controlled infusion of propofol and remifentanil，reaching a steady state after the target concentration of 10 min，the patients were transferred to the trendelenburg position（30 degrees），and maintained about 10 min；the patients were changed in supine position 10 min later，the position into reverse trendelenburg position were changed（30 degrees），also maintained about 10 min.Heart rate（HR），mean arterial pressure（MAP） and Narcotrend index were recorded separately at the time points of before trendelenburg position and reverse trendelenburg position（T0），immediately（T1），1 min later（T2），

3 min later（T3），5 min later（T4） and 10 min later（T5）.Compared the HR，MAP and Narcotrend index of the same body position at different points and at the same time point of the two postures.Result：In the trendelenburg position，MAP and Narcotrend of T2，T3 and T4 respectively compared with T0 were increased，the differences were statistically significant（P<0.05）；in the reverse trendelenburg position，MAP and Narcotrend Index of T2，T3 and T4 respectively compared with T0 were decreased，the difference were statistically significant（P<0.05）；at the same time point of T2，T3 and T4，the MAP and Narcotrend index of patients with the were lower than those of patients with reverse trendelenburg position，and the difference were statistically significant（P<0.05）.Conclusion：Elderly patients body position during intravenous anaesthesia can transient affect the Narcotrend index，of which will affect the anesthesiologists to judgment patients anesthesia depth.endprint

【Key words】 Narcotrend monitor； Total intravenous anesthesia； Depth of anesthesia； Posture； Elderly people

First-authors address：The First Peoples Hospital of Huizhou，Huizhou 516000，China

doi：10.3969/j.issn.1674-4985.2017.31.031

Narcotrend指數(shù)是以神經(jīng)電生理技術(shù)為基礎(chǔ)，用于監(jiān)測麻醉深度的指標(biāo)[1-2]。年齡、肌電活動等因素均可影響Narcotrend指數(shù)[3-5]，從而影響對麻醉深度的判斷。外科手術(shù)老年人患者越來越多，體位變化是手術(shù)中不可避免的問題，不同體位可影響大腦各腦室腦脊液和部位血流量的分布[6-7]。腦電雙頻指數(shù)（BIS）是基于神經(jīng)電生理技術(shù)的麻醉深度監(jiān)測指標(biāo)，與Narcotrend指數(shù)具有可比性[8-9]。研究發(fā)現(xiàn)在麻醉深度不變的情況下，體位因素可影響B(tài)IS值[10-11]，但是否會影響全麻老年患者Narcotrend指數(shù)尚有待研究。本研究擬評價在麻醉深度不變的情況下，體位因素對全麻老年患者Narcotrend指數(shù)的影響。現(xiàn)報道如下。

1 資料與方法

1.1 一般資料 選取2016年3-12月在惠州市第一人民醫(yī)院擇期行全麻手術(shù)患者30例。……