Narcotrend脑电监测在老年骨科手术患者中的应用

发布时间：2018-04-18 17:38

本文选题：Narcotrend + 老年病人　；参考：《吉林大学》2014年硕士论文

【摘要】：目的：观察Narcotrend脑电监测在老年骨科手术患者中的应用效果，为老年骨科手术全麻患者提供合理的麻醉方法。方法：选择自2013年7月~2014年3月全身麻醉下行择期骨科手术的老年患者，年龄65~80岁之间，所有手术患者均在全凭静脉麻醉下完成手术，术中麻醉维持以丙泊酚复合瑞芬太尼恒速输注，病人随机分为Narcotrend组（NT组，麻醉调节依据Narcotrend值）和对照组（C组，依据患者生命体征的变化，麻醉医生凭借个人临床经验进行麻醉深度的调节），每组患者30例。术中记录两组患者T1（麻醉诱导前10min）、T2（麻醉诱导后）、T3（气管插管后）、T4（手术开始时）、T5（手术结束时）、T6（拔除气管导管）、T7（入PACU）、T8（出PACU）8个时间点的平均动脉压（mean arterial pressure，MAP），心率（heart rate，HR）。并记录两组患者的手术时间，，麻醉时间，苏醒时间，拔管时间，PACU观察时间，麻醉维持药物丙泊酚，瑞芬太尼，血管活性药物的总剂量，术后24小时记录患者的术中知晓情况，术后恶心、呕吐发生情况。结果：NT组患者在各时间点的MAP,HR与对照组比较无统计学差异，两组患者术中血流动力学平稳。两组患者在手术时间及麻醉时间上比较无统计学差异。NT组患者苏醒时间，拔管时间及出PACU时间与对照组比较具有统计学差异，p0.05。NT组在整个手术过程中，丙泊酚总剂量，瑞芬太尼总剂量及去甲肾上腺素的剂量与对照组比较均明显减少，P0.05具有统计学差异。两组患者术后均无术中知晓的发生，恶心、呕吐的并发症无统计学差异。结论：Narcotrend脑电监测仪应用于老年骨科病人的手术术中监测，能够明显地减少术中丙泊酚及瑞芬太尼的用量，明显地缩短术后清醒及拔管时间，使停留在PACU时间更短，更有利于老年患者的麻醉管理。
[Abstract]:Objective: to observe the effect of Narcotrend EEG monitoring in elderly patients undergoing orthopaedic surgery, and to provide a reasonable anesthetic method for general anesthesia patients undergoing orthopaedic surgery.Methods: elderly patients with elective orthopedic surgery under general anesthesia from July 2013 to March 2014 were selected, aged between 65 and 80 years. All the patients underwent the operation under total intravenous anesthesia.The patients were randomly divided into Narcotrend group (NT group) and control group (C group according to the Narcotrend value), according to the changes of vital signs, the patients were given intraoperative anesthesia with propofol combined with remifentanil at constant rate.The anesthesiologist, with his own clinical experience, adjusts the depth of anesthesia in 30 patients in each group.T1 (10 min before anesthesia induction) and T2 (T3 after anesthesia induction) were recorded in both groups. The mean arterial pressure (mean arterial pressureMAPP, heart rate, heart rate) was observed at the beginning of the operation (T6) at the end of the operation.The operation time, anaesthesia time, recovery time, extubation time and PACU observation time, the total dose of propofol, remifentanil and vasoactive drugs were recorded.Postoperative nausea and vomiting occurred.Results there was no significant difference in MAPHR between the two groups at different time points. The hemodynamics of the two groups was stable during operation.There was no significant difference in the operation time and anesthesia time between the two groups. The recovery time, extubation time and PACU time of the NT group were significantly different from those of the control group. The total dose of propofol in the whole operation process of the NT group was significantly different from that of the control group.The total dose of remifentanil and the dose of norepinephrine were significantly decreased compared with the control group (P0.05).There was no significant difference in complications of nausea and vomiting between the two groups.Conclusion the application of the 10% Narcotrend EEG monitor in operative monitoring of senile orthopedic patients can significantly reduce the dosage of propofol and remifentanil during operation, shorten the time of postoperative wake up and extubation, and make the time of staying in PACU shorter.It is more beneficial to the anaesthesia management of the elderly patients.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.3

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