颅内动脉瘤患者全凭静脉麻醉下术中诱发电位的监测  

Effects of total intravenous anesthesia on evoked potentials during aneurysm clip placement surgery

作　　者：王立新[1] 王爱东[1] 韩如泉[1] 

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,100050

出　　处：《中华医学杂志》2012年第3期165-169,共5页National Medical Journal of China

基　　金：北京市科委科技新星资助项目（2007874）;北京市卫生系统高层次卫生技术人才培养计划（2009-3-19）

摘　　要：目的探讨全凭静脉麻醉下诱发电位（EP）监测成功率、可行性及对脑缺血的敏感性，并分析术后神经功能转归与影像学结果之间的相关性。方法2011年2-6月期间在北京天坛医院行颅内动脉瘤夹闭手术患者31例，采用异丙酚和瑞芬太尼全凭静脉麻醉，术中行体感诱发电位（SSEP）和运动诱发电位（MEP）监测，观察SSEP、MEP监测成功率，观察术后神经功能转归和影像学结果与诱发电位变化之间的关系。结果31例全部监测到双侧SSEP，1例未成功监测到对照侧MEP；3例患者出现术后神经功能缺损，其中1例术中SSEP、MEP同时出现波幅显著下降且未恢复至基线水平，术后出现偏瘫，CT扫描显示脑内多发缺血梗死灶。结论动脉瘤夹毕手术时采用异丙酚和瑞芬太尼全凭静脉麻醉，SSEP和MEP监测成功率高，有利于及早发现脑缺血，减少术后缺血性脑卒中的发生。Objective To explore the influences of total intravenous anesthesia （TIVA） on the feasibility and success rate of monitoring the evoked potentials （EP） and examine the correlations between EP changes and clinical outcomes in intracranial aneurysm surgery. Methods Thirty-one patients undergoing intracranial aneurysm surgery received TIVA. TIVA was maintained with a target controlled infusion （ TCI ） of propofol and a continuous infusion of remifentanyl. The bilateral SEP （ somatosensory evoked potential） and MEP （motor evoked potentials） were monitored intra-operatively. And the changes of evoked potential and success rate were recorded. The preoperative and postoperative neurological outcomes and radiological manifestations were compared. Results Bilateral SEP was detected in all cases. And the control side MEP was unsuccessfully monitored. Three patients had postoperative neurological deficits. The amplitudes of MEP and SEP declined simultaneously and failed to revert back to the baseline levels in 1 case. There was postoperative hemiplegia. And computed tomography showed multiple sites of ischemic brain infarction. Conclusion The administration of TIVA with propofol and remifentanyl enables successful SEP and MEP monitoring during intracranial aneurysm surgery. This protocol may detect early cerebral ischemia and reduce the incidence of ischemic stroke.

关 键 词：麻醉 静脉 颅内动脉瘤 诱发电位 躯体感觉 诱发电位 运动 监测 手术中 

分 类 号：R614[医药卫生—麻醉学]