Narcotrend 监测下全身麻醉对机体应激反应的影响

Effect of general anesthesia on stress response under the guidance of Narcotrend

摘要:

目的??探究 Narcotrend 监测下全身麻醉在直肠癌根治术快速康复外科中对机体应激反应的影响。 方法??选取 60 例采取快速康复外科治疗方案的择期行腹腔镜直肠癌根治术（Dixon）的患者，随机分为两组 ： N 组术中用 Narcotrend 监测调控麻醉深度， D 组为对照组， 术中凭血压、 心率和临床体征等经验调控麻醉深度， 每组 30 例，麻醉维持采用丙泊酚和瑞芬太尼持续输注，于两组麻醉前（T 0 ） 、麻醉中（T 1 ）即术中 30?min、麻醉后（T 2 ）即出麻醉恢复室时和术后 24?h（T 3 ）采集静脉血测定血清 C 反应蛋白（CRP） 、白细胞介素 6（IL-6）和皮质醇（Cor）的水平， 且以术后 10?min 内达到拔管标准顺利拔除气管导管者为快通道麻醉实施成功，观察两组患者快通道麻醉的成功例数和苏醒期躁动发生例数。 结果??D组的CRP在T 1~3 高于T 0 和N组 （ P ?<0.05） ，D 组的 IL-6 和 Cor 在 T 2 和 T 3 高于 T 0 和 N 组（ P ?<0.05） ； N 组快通道麻醉的成功率高于 D 组（ P ?<0.05） ；N 组苏醒期躁动发生率低于 D 组（ P ?<0.05） 。结论??Narcotrend 监测下的全身麻醉在直肠癌根治快速康复外科中能有效降低机体的应激反应， 有效达到快通道麻醉， 两者均符合快速康复外科理念的目标。

Abstract:

Objective To investigate the effect of general anesthesia on the stress response in enhanced recovery after surgery (ERAS) of colorectal cancer under the guidance of Narcotrend. Methods Sixty patients undergoing elective laparoscopic radical resection (Dixon) who underwent ERAS were randomly divided into two groups: N group was treated with Narcotrend to monitor the depth of anesthesia, and group D was the control group. According to the experience of blood pressure, heart rate and clinical signs, the depth of anesthesia was adjusted. Totally 30 patients in each group were treated with Propofol and Remifentanil for continuous infusion. Before the two groups of anesthesia (T 0 ), anesthesia (T 1 ) 30 minutes after surgery, after anesthesia (T 2 ), anesthesia recovery room and 24 hours after surgery (T 3 ), venous blood was collected for serum C-reactive protein (CRP) and interleukin 6 (IL-6) and the level of cortisol (Cor), and the successful removal of the tracheal tube within 10 min after the operation was successful for fast-track anesthesia. The success rate of fast-channel anesthesia and the agitation period in the two groups were observed. Results The CRP of group D was higher in T 1 -T 3 than in T 0 and N group (P < 0.05), and IL-6 and Cor in group D in T 2 and T 3 were higher than those in T 0 and N group (P < 0.05); the success rate of fast-channel anesthesia in group N was higher than that in group D (P < 0.05); the incidence of agitation in group N was lower than that in group D (P < 0.05). Conclusions The general anesthesia monitored by Narcotrend can effectively reduce the body's stress response in the ERAS of rectal cancer, and effectively achieve fast-track anesthesia. Both of them meet the goal of ERAS.