Narcotrend麻醉深度监测在小儿全身静脉麻醉中的应用

doi:10.3877/cma.j.issn.1673-5250.2014.04.023

目的

探讨Narcotrend麻醉深度监测在小儿全身静脉麻醉中的临床效果。

方法

选择2013年6月～11月于广州市妇女儿童医疗中心住院治疗的40例择期腹部手术患儿为研究对象，按照入院序号，将其随机分为研究组(n=20)和对照组(n=20)。本研究遵循的程序符合广州市妇女儿童医疗中心人体试验委员会所制定的伦理学标准，得到该委员会批准，分组征得受试对象监护人的知情同意，并与之签署临床研究知情同意书。两组患儿均接受丙泊酚-瑞芬太尼全身静脉麻醉，研究组患儿术中接受Narcotrend麻醉深度监测，对照组患儿术中根据常规临床监测指标调节麻醉深度。监测两组患儿术前、麻醉诱导后、手术开始、手术结束、拔管5个时间点的心率(HR)、平均动脉压(MAP)。记录苏醒时间及拔管时间、丙泊酚和瑞芬太尼的用量及术后不良反应发生率。

结果

两组患儿5个时间点HR和MAP的变化分别比较，差异均无统计学意义(P>0.05)，而研究组患儿全身麻醉中丙泊酚用量、术后苏醒时间及拔管时间均显著小于对照组[(122.71±21.06) mg vs. (181.08±25.97) mg，(4.37±2.05) min vs. (9.15±5.13) min，(6.68±2.32) min vs. (12.45±5.15) min]，并且差异有统计学意义(P<0.01)。两组术后无一例患儿出现明显恶心、呕吐等不良反应，术后24 h随访结果显示，均无麻醉并发症发生。

结论

Narcotrend麻醉深度监测有助于减少静脉全身麻醉中丙泊酚用量，缩短患儿术后苏醒时间和拔管时间。

关键词: Narcotrend, 监测，手术中, 麻醉，全身, 小儿

Objective

To explore the application of Narcotrend-assisted anesthesia in-depth monitor during total intravenous anesthesia in children.

Methods

From June to November 2013,a total of 40 children who underwent abdominal surgery were included in the study randomly. They were divided into Narcotrend group (n = 20) and control group (n = 20). All patients received total intravenous anesthesia with propofol and remifentanil. The patients in Narcotrend group adjusted anesthesia in-depth according to Narcotrend index (NTI). Those patients in control group adjusted anesthesia in-depth according to their heart rate(HR), mean arterial pressure (MAP) and movement. Changes of hemodynamics, durations of emergence and tracheal extubation were recorded. The doses of propofol and remifentanil and the incidence rates of postoperative nasea and vomiting were also recorded. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Guangzhou Women and Children's Medical Center. Informed consent was obtained from each participants' parents.

Results

There were no significant differences in HR and MAP at 5 observation time points between two groups (P> 0.05). The dose of propofol was lower in Narcotrend group than that of control group [(122.71±21.06) mg vs. (181.08±25.97) mg, P< 0.01]. The durations of emergence and tracheal extubation were respectively shorter in Narcotrend group than those of control group [(4.37±2.05) min vs. (9.15±5.13) min, (6.68±2.32) min vs. (12.45±5.15) min; P<0.01]. No one had postoperative nausea and vomiting in both groups.

Conclusion

Narcotrend-assisted anesthesia in-depth monitor can contribute to reduce the dose of propofol and shorten the duration of recovery during total intravenous anesthesia with propofol and remifentanil.

Key words: Narcotrend, Monitoring, intraoperative, Anesthesia, general, Child

表1 两组患儿一般情况比较(±s)

Table 1 Comparison of general clinical data between two groups(±s)

组别	n	年龄（岁）	性别[n(%)]		体质量(kg)	手术时间(min)
组别	n	年龄（岁）	男性	女性	体质量(kg)	手术时间(min)
研究组	20	5.72±2.83	14(70)	6(30)	17.18±5.12	77.92±23.56
对照组	20	5.35±2.52	13(65)	7(35)	16.37±4.04	83.61±21.74
t/χ²		0.604	0.134		0.055	0.034
P		0.659	0.792		0.891	0.645

表1 两组患儿一般情况比较(±s)

Table 1 Comparison of general clinical data between two groups(±s)

组别	n	年龄（岁）	性别[n(%)]		体质量(kg)	手术时间(min)
组别	n	年龄（岁）	男性	女性	体质量(kg)	手术时间(min)
研究组	20	5.72±2.83	14(70)	6(30)	17.18±5.12	77.92±23.56
对照组	20	5.35±2.52	13(65)	7(35)	16.37±4.04	83.61±21.74
t/χ²		0.604	0.134		0.055	0.034
P		0.659	0.792		0.891	0.645

表2 两组患儿5个时间点HR变化的比较(次/min，±s)

Table 2 Comparison of changes of HR at different observation time points between two groups(beats/min,±s)

组别	n	术前	麻醉诱导后	手术开始	手术结束	拔管
研究组	20	110±12	95±10	105±11	109±10	115±12
对照组	20	108±13	94±11	103±10	110±13	116±11
t		—0.013	-0.282	-0.511	0.242	0.202
P		0.766	0.349	0.300	0.792	0.644

表2 两组患儿5个时间点HR变化的比较(次/min，±s)

Table 2 Comparison of changes of HR at different observation time points between two groups(beats/min,±s)

组别	n	术前	麻醉诱导后	手术开始	手术结束	拔管
研究组	20	110±12	95±10	105±11	109±10	115±12
对照组	20	108±13	94±11	103±10	110±13	116±11
t		—0.013	-0.282	-0.511	0.242	0.202
P		0.766	0.349	0.300	0.792	0.644

表3 两组患儿5个时间点MAP变化的比较(mmHg，±s)

Table 3 Comparison of changes of MAP at different observation time points between two groups (mmHg,±s)

组别	n	术前	麻醉诱导后	手术开始	手术结束	拔管
研究组	20	70±6	61±5	72±8	69±7	74±7
对照组	20	72±7	58±6	71±8	70±7	75±8
t		0.985	-1.816	—0.389	0.837	0.416
P		0.420	0.094	0.783	0.483	0.228

表3 两组患儿5个时间点MAP变化的比较(mmHg，±s)

Table 3 Comparison of changes of MAP at different observation time points between two groups (mmHg,±s)

组别	n	术前	麻醉诱导后	手术开始	手术结束	拔管
研究组	20	70±6	61±5	72±8	69±7	74±7
对照组	20	72±7	58±6	71±8	70±7	75±8
t		0.985	-1.816	—0.389	0.837	0.416
P		0.420	0.094	0.783	0.483	0.228

表4 两组患儿苏醒时间、拔管时间、丙泊酚和瑞芬太尼用量比较(±s)

Table 4 Comparison of awake time, extubation time, doses of propofol and remifentanil between two groups(±s)

组别	n	苏醒时间(min)	拔管时间(min)	丙泊酚用量(mg)	瑞芬太尼用量(mg)
研究组	20	4.37±2.05	6.68±2.32	122.71±21.06	401.59±121.42
对照组	20	9.15±5.13	12.45±5.15	181.08±25.97	410.91±108.67
t		5.033	5.27	4.803	0.256
P		0.001	0.001	0.007	0.486

表4 两组患儿苏醒时间、拔管时间、丙泊酚和瑞芬太尼用量比较(±s)

Table 4 Comparison of awake time, extubation time, doses of propofol and remifentanil between two groups(±s)

组别	n	苏醒时间(min)	拔管时间(min)	丙泊酚用量(mg)	瑞芬太尼用量(mg)
研究组	20	4.37±2.05	6.68±2.32	122.71±21.06	401.59±121.42
对照组	20	9.15±5.13	12.45±5.15	181.08±25.97	410.91±108.67
t		5.033	5.27	4.803	0.256
P		0.001	0.001	0.007	0.486

1	Münte S, Klockars J, van Gils M, et al. The Narcotrend index indicates age-related changes during propofol induction in children [J]. Anesth Analg, 2009, 109(1):53-59.
2	Shariat Moharari R, Samadi A, Imani F, et al. The effect of epidural bupivacaine on BIS levels in the awake phase and on the maintenance doses of propofol and fentanyl during general anesthesia[J]. Anesth Pain Med, 2013, 2(4):149-153.
3	Hadavi SM, Allahyary E, Asadi S. Evaluation of the adequacy of general anesthesia in cesarean section by bispectral index[J]. Iran J Med Sci, 2013, 38(3):240-247.
4	Nishiyama T. Composite-, plain-auditory evoked potentials index and bispectral index to measure the effects of sevoflurane[J]. J Clin Monit Comput, 2013, 27(3):335-339.
5	Kuhnle GE, Hornuss C, Lenk M, et al. Impact of propofol on mid-latency auditory-evoked potentials in children [J]. Br J Anaesth, 2013, 110(6):1001-1009.
6	Khan S, Chiplonkar S, Sinha M. Entropy decreases post-operative morbidity in patients undergoing major gynaecological laparoscopic surgery[J]. Eur J Anaesthesiol, 2011, 28(9):672.
7	Klockars JG, Hiller A, Münte S, et al. Spectral entropy as a measure of hypnosis and hypnotic drug effect of total intravenous anesthesia in children during slow induction and maintenance [J]. Anesthesiology, 2012, 116(2):340-351.
8	Amigoni A, Mozzo E, Brugnaro L, et al. Assessing sedation in a pediatric intensive care unit using Comfort Behavioural Scale and bispectral index: these tools are different[J]. Minerva Anestesiol, 2012, 78(3):322-329.
9	Bauerle K, Greim CA, Schroth M. Prediction of depth of sedation and anesthesia by the Narcotrend EEG monitor [J]. Br J Anesth, 2004, 92(6):841-859.
10	Otto KA, Cebotari S, Höffler HK, et al. Electroencephalographic Narcotrend index, spectral edge frequency and median power frequency as guide to anaesthetic depth for cardiac surgery in laboratory sheep[J]. Vet J, 2012, 191(3):354-359.
11	Jiang Y, Qiao B, Wu L, et al. Application of Narcotrend monitor for evaluation of depth of anesthesia in infants undergoing cardiac surgery: a prospective control study[J]. Braz J Anesthesiol, 2013, 63(3):273-278.
12	Kreuer S, Bruhn J, Stracke C, et al. Narcotrend or bispectral index monitoring during desflurane-remifentanil anesthesia: a comparison with a standard practice protocol [J]. Anesth Analg, 2005, 101(2):427-434.
13	Schmidt GN, Bischoff P, Standl T, et al. Narcotrend and Bispectral Index monitor are superior to classic electroencephalographic parameters for the assessment of anesthetic states during propofol-remifentanil anesthesia [J]. Anesthesiology, 2003, 99(5):1072-1077.
14	Shepherd J, Jones J, Frampton G, et al. Clinical effectiveness and cost-effectiveness of depth of anaesthesia monitoring (E-entropy, bispectral index and narcotrend): a systematic review and economic evaluation[J]. Health Technol Assess, 2013, 17(34):1-264.
15	Weber F, Hollnberger H, Weber J. Electroencephalographic Narcotrend index monitoring during procedural sedation and analgesia in children[J]. Paediatr Anaesth, 2008, 18(9):823-830.
16	Wallenborn J, Kluba K, Olthoff D. Comparative evaluation of bispectral index and narcotrend index in children below 5 years of age[J]. Paediatr Anaesth, 2007, 17(2):140-147.
17	Rundshagen I, Hardt T, Cortina K, et al. Narcotrend-assisted propofol/remifentanil anaesthesia vs clinical practice: does it make a difference? [J]. Br J Anesth, 2007, 99(5):686-693.
18	Amornyotin S, Chalayonnawin W, Kongphlay S. Deep sedation for endoscopic retrograde cholangiopancreatography: a comparison between clinical assessment and Narcotrend(TM) monitoring[J]. Med Devices (Auckl), 2011, 4:43-49.
19	高玉洁，鲍红光，韩流，等．Narcotrend监测下观察七氟烷和丙泊酚在无痛人流手术中的应用[J/CD]．中华临床医师杂志：电子版，2013，7(18)：8203-8205.
20	Haller G, Stoelwinder J, Myles P, et al. Quality and safety indicators in anesthesia[J]. Anesthesiology, 2009, 110(5):1158-1175.

[1]	李文秀, 杨爽, 吴江, 耿斌, 苏俊武. 二维经胸超声心动图诊断小儿二尖瓣裂的价值[J/OL]. 中华医学超声杂志（电子版）, 2023, 20(11): 1186-1192.
[2]	李浩纶, 杨佳麒, 李羽. 盐酸氢吗啡酮在小儿术后镇痛作用中的研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(02): 166-171.
[3]	黄来明, 张旭东. 雾化吸入布地奈德混悬液联合气管导管涂抹达克罗宁胶浆对改善妇科腹腔镜手术气管插管全身麻醉患者咽喉部不适作用[J/OL]. 中华妇幼临床医学杂志(电子版), 2023, 19(04): 480-486.
[4]	杨小栎, 李万富, 马柱, 马兰, 郑义, 付晓丽, 王晶. 钳式针一步法在小儿腹腔镜疝囊高位结扎术中的应用效果[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 535-538.
[5]	李彬瑶, 邓富铭, 高晓峰, 赵彰, 张正涛, 周锐, 朱士博, 钟竞斌, 刘国昌, 伏雯. 机器人手术系统在小儿泌尿外科的应用与进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(03): 284-288.
[6]	马涛, 叶春伟, 刘滔, 彭文希, 李志鹏. 腹腔镜与开放性离断式肾盂成形术治疗小儿肾盂输尿管连接部梗阻的比较[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 605-610.
[7]	贺翔, 杨科, 曹义国, 陈贵恒. 腹腔镜治疗小儿鞘膜积液的研究进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 526-528.
[8]	朱明, 童国煜, 赵海腾, 钟量, 邹翔宇, 吴少峰, 张轶男. 腹腔镜在减少儿童隐匿性腹股沟斜疝与鞘膜积液二次手术的意义[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 457-460.
[9]	吴少峰, 张轶男, 孙杰. 机器人辅助手术在儿童微创泌尿手术中的应用和展望[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 440-444.
[10]	李志全, 王茜, 赵泽宇. 单用喉罩全身麻醉或联合骶管阻滞在儿童疝囊高位结扎术中的效果比较[J/OL]. 中华疝和腹壁外科杂志(电子版), 2023, 17(03): 322-325.
[11]	曹伟, 李艳玲, 李亚辉, 张文化. 蓝芩口服液联合重组人干扰素α-2b喷雾治疗急性期小儿疱疹性咽峡炎的临床分析[J/OL]. 中华肺部疾病杂志(电子版), 2023, 16(02): 221-223.
[12]	黄泽辉, 梁杰贤, 曾伟. 右美托咪定联合艾司氯胺酮在小儿无痛胃镜检查中的应用研究[J/OL]. 中华消化病与影像杂志(电子版), 2023, 13(06): 510-513.
[13]	卢贤红, 钱石陆, 周敏. 微生态调节剂对小儿轮状病毒性肠炎的临床干预效果分析[J/OL]. 中华消化病与影像杂志(电子版), 2023, 13(04): 245-249.
[14]	李秋琼, 薛静, 王敏, 陈芬, 肖美芳. NSE、SIL-2R、TNF-α检测对小儿病毒性脑膜炎与细菌性脑膜炎的诊断价值[J/OL]. 中华临床医师杂志(电子版), 2023, 17(03): 303-307.
[15]	杨钲, 苏桂新, 宋光彩, 习鹏娇. EDTA依赖性聚集致小儿血小板假性减少1例[J/OL]. 中华临床实验室管理电子杂志, 2024, 12(02): 114-117.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Application of Narcotrend-Assisted Anesthesia In-Depth Monitor During Total Intravenous Anesthesia in Children

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Application of Narcotrend-Assisted Anesthesia In-Depth Monitor During Total Intravenous Anesthesia in Children