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【摘要】 目的：探讨在麻醉深度不变的情况下，体位因素对全麻老年患者Narcotrend指数的影响。方法：择期全凭静脉麻醉手术患者30例，年龄60～80岁，ASAⅡ～Ⅲ级，体重指数18～24 kg/m2。麻醉诱导静脉注射舒芬太尼、丙泊酚、顺阿曲库胺，Narcotrend指数值40～45时行气管插管全凭静脉麻醉，麻醉维持予以血浆靶控输注丙泊酚和瑞芬太尼，达到稳态靶浓度后10 min时将患者调至头低脚高位（30°），记录头低体位前（T0）、頭低体位即刻（T1）、1 min（T2）、3 min（T3）、5 min（T4）和10 min（T5）时HR、MAP、Narcotrend指数值；将患者调至平卧位，10 min后再调至头高脚低位（30°），记录头高体位前（T0）、头高体位即刻（T1）、1 min（T2）、3 min（T3）、5 min（T4）和10 min（T5）时HR、MAP、Narcotrend指数值。比较同一体位不同时点、两种体位同一时间点的HR、MAP、Narcotrend指数。结果：患者头低脚高位，T2、T3、T4时MAP、Narcotrend指数分别与T0时比较均升高，差异均有统计学意义（P<0.05）；患者头高脚低位，T2、T3、T4时MAP、Narcotrend指数分别与T0时比较均下降，差异均有统计学意义（P<0.05）；T2、T3、T4三个相同时间点，头高脚低位患者的MAP、Narcotrend指数均低于头低脚高位患者，比较差异均有统计学意义（P<0.05）。结论：体位改变对全凭静脉麻醉老年患者Narcotrend指数可引起一过性改变，影响麻醉医师对患者麻醉深度的判断。
【关键词】 Narcotrend脑电监测； 全凭静脉麻醉； 麻醉深度； 体位； 老年人
【Abstract】 Objective：To investigate the effects of posture on the Narcotrend index in elderly patients undergoing total intravenous anaesthesia.Method：30 patients with elective total intravenous anesthesia were selected，aged 60-80 years，ASA grade Ⅱ-Ⅲ，body mass index 18-24 kg/m2.Anesthesia was induced by intravenous injection of sufentanil，propofol，cisatracurium besylate.Narcotrend index of 40 to 45 when tracheal intubation general anesthesia， anesthesia to maintain plasma target-controlled infusion of propofol and remifentanil，reaching a steady state after the target concentration of 10 min，the patients were transferred to the trendelenburg position（30 degrees），and maintained about 10 min；the patients were changed in supine position 10 min later，the position into reverse trendelenburg position were changed（30 degrees），also maintained about 10 min.Heart rate（HR），mean arterial pressure（MAP） and Narcotrend index were recorded separately at the time points of before trendelenburg position and reverse trendelenburg position（T0），immediately（T1），1 min later（T2），
3 min later（T3），5 min later（T4） and 10 min later（T5）.Compared the HR，MAP and Narcotrend index of the same body position at different points and at the same time point of the two postures.Result：In the trendelenburg position，MAP and Narcotrend of T2，T3 and T4 respectively compared with T0 were increased，the differences were statistically significant（P<0.05）；in the reverse trendelenburg position，MAP and Narcotrend Index of T2，T3 and T4 respectively compared with T0 were decreased，the difference were statistically significant（P<0.05）；at the same time point of T2，T3 and T4，the MAP and Narcotrend index of patients with the were lower than those of patients with reverse trendelenburg position，and the difference were statistically significant（P<0.05）.Conclusion：Elderly patients’ body position during intravenous anaesthesia can transient affect the Narcotrend index，of which will affect the anesthesiologists to judgment patients’ anesthesia depth.
【关键词】 Narcotrend脑电监测； 全凭静脉麻醉； 麻醉深度； 体位； 老年人
【Abstract】 Objective：To investigate the effects of posture on the Narcotrend index in elderly patients undergoing total intravenous anaesthesia.Method：30 patients with elective total intravenous anesthesia were selected，aged 60-80 years，ASA grade Ⅱ-Ⅲ，body mass index 18-24 kg/m2.Anesthesia was induced by intravenous injection of sufentanil，propofol，cisatracurium besylate.Narcotrend index of 40 to 45 when tracheal intubation general anesthesia， anesthesia to maintain plasma target-controlled infusion of propofol and remifentanil，reaching a steady state after the target concentration of 10 min，the patients were transferred to the trendelenburg position（30 degrees），and maintained about 10 min；the patients were changed in supine position 10 min later，the position into reverse trendelenburg position were changed（30 degrees），also maintained about 10 min.Heart rate（HR），mean arterial pressure（MAP） and Narcotrend index were recorded separately at the time points of before trendelenburg position and reverse trendelenburg position（T0），immediately（T1），1 min later（T2），
3 min later（T3），5 min later（T4） and 10 min later（T5）.Compared the HR，MAP and Narcotrend index of the same body position at different points and at the same time point of the two postures.Result：In the trendelenburg position，MAP and Narcotrend of T2，T3 and T4 respectively compared with T0 were increased，the differences were statistically significant（P<0.05）；in the reverse trendelenburg position，MAP and Narcotrend Index of T2，T3 and T4 respectively compared with T0 were decreased，the difference were statistically significant（P<0.05）；at the same time point of T2，T3 and T4，the MAP and Narcotrend index of patients with the were lower than those of patients with reverse trendelenburg position，and the difference were statistically significant（P<0.05）.Conclusion：Elderly patients’ body position during intravenous anaesthesia can transient affect the Narcotrend index，of which will affect the anesthesiologists to judgment patients’ anesthesia depth.