听觉诱发电位指数在脊柱侧弯矫形手术唤醒过程中的变化  

Changes of auditory evoked potential indexes during awakening process after scoliosis surgery

作　　者：孙雪峰[1] 郝建华[1] 张英民[1] 刘甦[1] 

机构地区：[1]解放军总医院第三○四临床部麻醉科,北京市100037

出　　处：《中国临床康复》2005年第17期26-27,共2页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:观察听觉诱发电位指数在脊柱侧弯矫形手术唤醒过程的变化,探讨听觉诱发电位指数对体动反应和术中记忆的意义。方法:15例择期脊柱侧弯矫形手术病例,采用异丙酚-氧化亚氮复合麻醉。用A-line监护仪监测麻醉和唤醒过程的听觉诱发电位指数。结果:麻醉诱导前基础听觉诱发电位指数为78.7±14.3。麻醉过程中听觉诱发电位指数最高值为35.2±14.2,最低值10.3±3.6,平均值21.9±3.9。平均值、最高值、最低值之间的差异有显著性意义,说明听觉诱发电位指数存在较大的自身波动。唤醒试验中停药即刻听觉诱发电位指数为18.7±6.3,自主体动时27.7±8.4,指令活动时71.3±16.3。自主活动时听觉诱发电位指数与最高值和平均值的差异无显著性意义,说明听觉诱发电位指数并不能预示体动反应。指令活动时的听觉诱发电位指数显著高于麻醉过程中的听觉诱发电位指数提示听觉诱发电位指数可以很好地预示指令活动。所有患者对术中唤醒过程都没有记忆,表明听觉诱发电位指数不能特异地预示术中知晓。结论:尽管听觉诱发电位指数本身有较大的波动,但是可以很好的预示指令活动的出现,因此可以反映麻醉恢复期患者意识的恢复,但是实验中未发现听觉诱发电位指数对体动反应和术中记忆具有预示意义。AIM:To investigate the changes of auditory evoked potential index(A line ARX index,AAI) during awakening test in scoliosis correction surgeries and study its value in prediction of spontaneous movement and awareness during anesthesia.METHODS:Fifteen scoliosis patients were enrolled who underwent correction operations under propofol nitrous oxide general anesthesia.The AAI during anesthesia and awakening test was monitored with A line monitor.RESULTS:The basic AAI before anesthesia induction was 78.7± 14.3.The maximum,minimum and mean AAI during anesthesia was 35.2± 14.2,10.3± 3.6 and 21.9± 3.9 respectively and there was significant difference among them,which indicated that AAI fluctuated itself at a large scale during anesthesia.During awakening test,the AAI at the moment of drug withdrawal,spontaneous movement and ordered movement was 18.7± 6.3,27.7± 8.4 and 71.3± 16.3 respectively.There was no significant difference between spontaneous movement AAI and maximum or mean AAI during anesthesia,which indicated that AAI was not a valid predictor of spontaneous movement during anesthesia.But the AAI was significantly increased when ordered movement occurred,indicating that the AAI could quite predict ordered movement.No patients had memory of events of operations and awakening test,showing that AAI could not specifically predict awareness during operation.CONCLUSION:The AAI is a good predictor of ordered movement,though the AAI itself had a great fluctuation,so it can detect the transition to consciousness after anesthesia.But the AAI is not found any predicting value of spontaneous movement and awareness during anesthesia in this study.

关 键 词：脊柱侧凸 诱发电位 听觉 记忆 

分 类 号：R74[医药卫生—神经病学与精神病学]