郭鑫+侯芝绮+罗欢欢

[摘要]目的 探討Narcotrend（NT）麻醉深度监测在老年高血压患者全麻苏醒气管拔管中的应用效果。方法 选择我院2015年8月～2016年6月择期行全麻手术的老年高血压患者90例。根据苏醒期NT值，所有患者随机分成三组，每组30例。复苏期NT值：A组维持在55.0±5.0，B组为75.0±5.0，C组为95.0±5.0。所有患者术前血压控制在160/100 mmHg以下，从麻醉开始到患者苏醒拔管持续进行NT监测。手术结束后持续输注丙泊酚直至拔管，患者呼吸完全恢复后，拔除气管导管，拔管后即刻停止丙泊酚输注，比较三组患者拔管前后MAP和HR的变化，苏醒时间，拔管后镇静/警觉（OAA/S）评分，呛咳反应，口咽通气道使用率及拔管知晓率。结果 拔管前后A、B两组患者的MAP和HR无明显变化（P>0.05）；拔管后C组MAP和HR较拔管前显著增加（P<0.05）；C组拔管后MAP和HR较A、B两组显著增加（P<0.05）；A组口咽通气道使用率和清醒时间较B组和C组显著增加，C组呛咳率、拔管知晓率明显高于A、B两组，差异有统计学意义（P<0.05）。结论 老年高血压患者镇静下比较合理的拔管时机为NT值为75.0±5.0。

[关键词]Narcotrend监测；全麻苏醒期；气管拔管；高血压

[中图分类号] R614 [文献标识码] A [文章编号] 1674-4721（2017）05（c）-0049-05

[Abstract]Objection To investigate the application effect of Narcotrend monitoring in tracheal extubation in elderly patients with hypertension during general anesthesia recovery time.Methods 90 elderly hypertensive patients in our hospital from August 2015 to June 2016 undergoing elective operation in general anesthesia were selected.All patients were randomly divided into three groups（n=30） according to the NT value during recovery time.The NT value of recovery period：group A was maintained was 55.0±5.0，group B was 75.0±5.0，group C was 95.0±5.0.Preoperative blood pressure was controlled below 160/100 mmHg in all patients，and NT monitoring was performed from the beginning of anesthesia to the recovery of patients.After the end of surgery continous infusion of propofol until extubation.The endotracheal tube was removed after full recovery of respiration and the propofol infusion was stopped immediately after extubation.Compared the changes of MAP and HR before and after extubation of three groups of patients，recovery time，observers assessment of alertness/sedation（OAA/S） scale，cough reaction，oropharygeal airway utilization and extubation awareness incidence.Results There were no significant changes of MAP and HR in groups A and B before and after extubation（P>0.05）.After extubation，MAP and HR of group C increased significantly compared with before extubation（P<0.05）.MAP and HR in group C were significantly higher than those in group A and B after extubation（P<0.05）.Compared with group B and C，the oropharyngeal airway utilization and awake time of group A increased significantly，the difference was statistically significant（P<0.05）.The rate of cough and extubation awareness of group C were significantly higher than that of group A and B （P<0.05）.Conclusion The NT value of 75.0±5.0 can be a proper indication of tracheal extubation under deep sedation in elder patients with hypertension.

[Key words]Narcotrend；General anesthesia recovery time；Tracheal extubation；Hypertension

随着社会的老龄化，老年患者的数量也不断增加。老年患者往往有外科疾病的同时合并有高血压、冠心病等[1]。老年高血压患者，由于长期血压偏高使心血管功能下降，患者围术期心血管不良事件发生率较高，在全麻诱导、维持和苏醒过程中血压容易产生波动。全麻苏醒拔管期是全身麻醉过程中风险较高的一个时期，拔管过程中的强烈刺激可能引起血压、心率的剧烈波动，有引发心肌梗死和脑出血的风险。拔管期的风险引起了麻醉医生的重视，通过给予心血管活性药物可以控制拔管期的循环波动，但是并不能完全抑制拔管期的应激反应。有……