陈枝 罗海东 林跃华 张岳农

[摘要]目的 探討Narcotrend监测下依托咪酯及丙泊酚麻醉维持在老年患者腹腔镜手术中的应用效果。方法 选取2016年3月～2017年3月我院麻醉一科收治的100例需实施腹腔镜手术的老年患者为研究对象，按患者就诊的单双月分为两组。两组均接受静脉复合麻醉方法，均使用依托咪酯及丙泊酚麻醉维持。对照组结合血压变化、心率变化等症状体征及临床经验给予调整输注速度；研究组则Narcotrend监测下调整输注速度。结果 两组入室时及麻醉诱导前5 s的HR、MAP及麻醉趋势指数比较，差异均无统计学意义（P>0.05）；研究组插管、插管后5 min、睁眼、拔管、出室的HR、MAP指标及麻醉趋势指数均低于对照组（P<0.05），研究组清醒时间、拔管时间及定向力恢复时间均短于对照组，差异均有统计学意义（P<0.05）；两组的不良反应发生率比较，差异无统计学意义（P>0.05）。结论 在老年患者腹腔镜手术中应用Narcotrend监测下依托咪酯及丙泊酚麻醉维持可明显减少患者HR、MAP指标及麻醉趋势指数，明显患者缩短清醒时间、拔管时间及定向力恢复时间，明显降低不良反应发生率，安全性高，有重要临床应用价值。

[关键词]Narcotrend监测；依托咪酯；丙泊酚；麻醉维持；老年；腹腔镜手术

[中图分类号] R614 [文献标识码] A [文章编号] 1674-4721（2018）4（c）-0061-03

Application effect of Etomidate and Propofol anesthesia under Narcotrend monitoring maintaining laparoscopic surgery in elderly patients

CHEN Zhi LUO Hai-dong LIN Yue-hua ZHANG Yue-nong

First Department of Anesthesia，Meizhou People′s Hospital，Guangdong Province，Meizhou 514031，China

[Abstract]Objective To investigate the application effect of Etomidate and Propofol anesthesia under Narcotrend monitoring maintaining the elderly patients undergoing laparoscopic surgeries.Methods A total of 100 elderly patients undergoing laparoscopic surgeries in our department from March 2016 to March 2017 were selected as the subjects.They were divided into two groups according to single or double month visit doctor.Both groups were provided with intravenous anesthesia maintaining by Etomidate and Propofol.In the control group，the infusion rate was adjusted based on symptoms and signs such as changes in blood pressure，heart rate （HR），and clinical experience，while in the research group，the infusion rate was changed based on Narcotrend monitoring.Results There was no difference in HR，mean arterial pressure （MAP） and anesthetic trend index between the two groups at the time of group entry and 5 s before induction of anesthesia（P>0.05）.In the research group，the indices of HR，MAP，and anesthetic trend index at intubation，5 minutes after intubation，eye-opening，extubation，and department leaving were all lower than those in the control group（P<0.05）.The awake time，extubation time，and time of orientation recovery in the research group were all shorter compared with those in the control group，the differences were stistically significant （P<0.05）.No significant difference in the incidence of adverse reactions was displayed in the two groups （P>0.05）.Conclusion For elderly patients undergoing laparoscopic surgery，Etomidate and Propofol maintenance of anesthesia under Narcotrend monitoring can significantly reduce the indices of HR，MAP，and anesthetic trend index，shorten awake time，extubation time，and time of orientation recovery，and decrease the incidence of adverse reactions in high safety，which has an important clinical application value.

[Key words]Narcotrend monitoring；Etomidate；Propofol；Anesthesia maintenance；The elderly；Laparoscopic surgery

老年人由于年龄增长，且机体各项生理功能逐渐下降，且多伴有冠心病、高血压、糖尿病等基础疾病，导致手术耐受力降低，老年腹腔镜手术的麻醉难度以及风险性增加。因此，术前给予老年患者针对性的生理评估及病理评估十分重要[1]。在实施腹腔镜手术中，临床采取静脉复合全身麻醉为最常采用的麻醉手段。且随着腹腔镜手术越来越广泛应用临床，静脉复合全身麻醉应用率也随着增高，临床对脉复合全身麻醉也越来越高要求。以……