全身麻醉影响下的经颅磁刺激运动诱发电位术中监测指标的评价  

Distinguish reasons for the variety of intraoperative transcranial magnetic motor evoked potential： the anaesthesia or the operative injury

作　　者：谢红雯[1] 袁庆国[1] 沙成[1] 姜宏志[1] 杨玉明[1] 王大明[1] 

机构地区：[1]卫生部北京医院神经外科,100730

出　　处：《中华外科杂志》2012年第6期529-533,共5页Chinese Journal of Surgery

基　　金：基金项目：首都医学发展科研基金资助项目（ZD199802）作者单位：100730卫生部北京医院神经外科

摘　　要：目的通过对相关麻醉监测指标与运动诱发电位（MEP）相互关系的分析，探讨全身麻醉下更可靠地评价MEP监测指标的方法。方法选取2001年2月至2004年6月26例接受脊柱脊髓手术的患者，术中使用依托咪酯和芬太尼进行麻醉，应用双频指数（BIS）和四个成串刺激（TOF）监测麻醉深度与肌松状态，使用经颅磁刺激运动诱发电位（TMS—MEP）进行术中监测。记录不同麻醉深度与肌松状态下的TMS—MEP，分析MEP随着麻醉深度与肌松状态而变化的规律，并尝试利用这一规律来分析术中MEP变化的原因。结果所有病例麻醉状态下MEP的波幅均与相应时间的BIS和TOF监测指标呈正相关，多元回归分析可以在这些指标问建立有效的回归方程（F=15．274～152．513，P〈0．01）。当麻醉深度与肌松状态发生变化时，将对应的BIS和T1／Tc输入该回归方程，可以对MEP的波幅进行有效地预测。在手术操作导致MEP波幅降低的情况下，MEP波幅的实测值会显著偏离预测值，从而有利于区分MEP变化的真实原因是手术操作，还是麻醉深度与肌松状态的改变。不同患者回归方程的截距与偏回归系数各不相同，且差异较大，回归方程在不同患者之间不能相互替代。结论将麻醉与肌松的监测指标BIS、T1／Tc以及相应的回归方程纳入MEP术中监测结果的分析，是一个非常实用而且有效的方法，可用以排除麻醉状态的波动对MEP变化原因判断的干扰。Objective To find a way to discriminate operative reason from anaesthesia reason for the changes of intraoperative transcranial magnetic motor evoked potentials （MEPs）. Methods In 26 patients under Etomidate/Fentanyl anesthesia from Feburary 2001 to June 2004, MEPs elicited by transcranial magnetic stimulation were recorded from tibialis anterior muscles, simultaneously bispectral index （BIS） and train-of-four stimulation （TOF） were used to monitor the anesthesia depth and neuromuscular blockade respectively. MEP, BIS and measurements of TOF at different anesthesia depth and muscular relaxation were recorded synchronously, statistical analysis of this data set was done in order to find the inherent relationship between these variables. Results Under anesthesia, MEP amplitude was always positively correlated with the corresponding BIS and TOF value. A regression equation could be built, with which the MEP amplitude could be reckoned based on reahime BIS and T1/Tc. In case of spinal cord injury, the measured amplitude value would significantly deviate from predicted one, which suggested that the change of MEP was because of the operation, but not the anaesthesia or neuromuscular blockade. Each patient had his or her own regression equation, which was different from each other. Conclusions The establishment of regression equation from MEPs, BIS and TOF is very useful to distinguish reasons of the changes of transcranial magnetic MEPs during surgery, and with this technique, the intraoperative MEP monitoring should be more reliable and practicable.

关 键 词：麻醉 全身 诱发电位 运动 经颅磁刺激 监测 手术中 神经肌肉阻滞 

分 类 号：R614[医药卫生—麻醉学]