摘要
目的通过观察Narcotrend指数(NTI)的变化,探讨全凭静脉麻醉中二氧化碳(CO_2)气腹对麻醉深度的影响。方法选择60例妇科腹腔镜手术患者,随机分为观察组和对照组,观察组气腹后不调整通气量,允许呼气末二氧化碳(P_(ET)CO_2)≤50 mmHg,而对照组气腹后调整通气量,使P_(ET)CO_2保持在30～35 mmHg,分别记录两组气腹前(T0)、气腹后10 min(T1)、20 min(T2)、30 min(T3)和45 min(T4)的NTI和P_(ET)CO_2,并于T2和T4时刻行血气分析以监测动脉血二氧化碳分压(Pa CO_2),研究期间麻醉维持均采用靶控输注(TCI)相同浓度的丙泊酚和持续输注瑞芬太尼。结果对照组气腹前后各时间点的P_(ET)CO_2和NTI值比较差异无统计学意义(P>0.05);观察组T4时刻的P_(ET)CO_2显著高于T0,T4时刻的NTI值显著高于T0和T1(P<0.05)。观察组在T4时刻的P_(ET)CO_2、Pa CO_2和NTI值均显著高于对照组(P<0.05);线性回归分析显示,观察组P_(ET)CO_2与NTI具有高度相关性(r=0.897,P<0.05)。结论丙泊酚复合瑞芬太尼全凭静脉麻醉下腹腔镜CO_2气腹引起的高碳酸血症可影响Narcotrend监测,可引起NTI假性升高,在临床应用中需引起重视。
Objective To observe influence of carbon dioxide pneumoperitoneum on the Narcotrend index during total intravenous anesthesia so as to explore the impact of carbon dioxide on the depth of anesthesia.MethodsSixty patients with gynecologic laparoscopic surgery under total intravenous anesthesia were randomly divided into two groups,control group and study group.After pneumoperitoneum,in the study group P（ET）CO2 was permitted not exceed 50 mm Hg while ventilation parameter was not changed.In control group P（ET）CO2 was maintained at 30-35 mmHg by adjusting ventilation parameter.P（ET）CO2 and NTI were recorded before pneumoperitoneum（T0）and 10 min（T1）,20 min（T2）,30 min（T3）and 45 min（T4）after pneumoperitoneum.The arterial blood gas analysis was monitored at T2 and T4.Anesthesia was maintained with TCI with the same concentration of propofol and continuous infusion of remifentanil.Results In control group,P（ET）CO2 and NTI remained constant after pneumoperitoneum（P〉0.05）.In study group,P（ET）CO2 at T4 was significantly increased than that at T0,and NTI at T4 was significantly increased than those at T0 and T1（P〈0.05）.Compared with control group,P（ET）CO2,Pa CO2 and NTI were significantly increased in study group（P〈0.05）.Liner regression showed highly linear correlation between P（ET）CO2 and NTI in study group（r=0.897,P〈0.05）.ConclusionHypercapnia caused by carbon dioxide pneumoperitoneum under propofol-remifentanil total intravenous anesthesia can affect the Narcotrend index during laparoscopic surgery and induce pseudo-rise of NTI.
作者
郭锐
钟茂林
叶军明
曾凡颖
许厚仁
王力峰
林勇
GUO Rui;ZHONG Mao-lin;YE Jun-ming;ZENG Fan-ying;XU Hou-ren;WANG Li-feng;LIN Yong(Department of Anesthesiology,the First Affiliated Hospital of Gannan Medical College,Ganzhou 341000,Jiangxi,China)
出处
《广东医学》
CAS
2018年第14期2143-2146,共4页
Guangdong Medical Journal
基金
江西省卫生计生委科技项目(编号:20175356)
