不同剂量肌肉松弛药静脉维持对面肌痉挛微血管减压术中面神经复合肌肉动作电位的影响  

Effects of different doses of muscle relaxant in intravenous maintenance anesthesia on compound muscle action potential in microvascular decompression for facial spasm

作　　者：陈琦[1,2] 邓小明[1] 施君[3] 

机构地区：[1]上海长海医院麻醉科,上海200433 [2]上海交通大学医学院附属新华医院麻醉与重症医学科 [3]上海交通大学医学院附属新华医院神经外科

出　　处：《上海医学》2014年第2期128-130,共3页Shanghai Medical Journal

摘　　要：目的观察各种不同剂量肌肉松弛药静脉维持在面肌痉挛微血管减压术(MVD)中对面神经复合肌肉动作电位(CMAP)的影响。方法 150例择期行面肌痉挛MVD的患者,美国麻醉医师学会分级Ⅰ或Ⅱ级,按肌肉松弛药的给药方式随机分入单次追加组、常规剂量维持组和小剂量维持组。所有患者接受全凭静脉麻醉,术中监测肌肉松弛程度,观察4个成串刺激中第4个与第1个肌颤搐幅度比值(T4/T1比值)。比较麻醉诱导前(无肌肉松弛状态下)和麻醉诱导后0.5、1、1.5、2h,面神经CMAP的波幅和潜伏期。结果单次追加组中1例患者在T4/T1比值尚为0时已发生体动,经静脉注射维库溴铵0.04mg/kg,及追加静脉注射丙泊酚1mg/kg后体动消失;普通剂量维持组、小剂量维持组患者未发生术中体动。单次追加组和普通剂量维持组在麻醉诱导后0.5、1、1.5、2h时CMAP波幅均显著小于同组麻醉诱导前(P值均<0.05),潜伏期均显著长于同组麻醉诱导前(P值均<0.05);小剂量维持组不同时间CMAP波幅和潜伏期的差异均无统计学意义(P值均>0.05)。结论全凭静脉麻醉时,在肌肉松弛监测的条件下,通过定量肌肉松弛的方法行面神经监测是可行的。这样既能在术中为手术医师提供有效的面神经监测,保障手术操作的成功,又能避免患者因术中发生体动对手术和面神经本身造成影响和伤害,甚至导致严重的后果。Objective To observe the effects of different doses of muscle relaxant in intravenous maintenance anesthesia on compound muscle action potential （CMAP） in microvascular decompression （MVD） for hemifacial spasm. Methods One hundred and fifty hemifacial spasm patients scheduled for MVD, American Society of Anesthesiologists grade I or II, were randomly divided into three groups according to the different doses of muscle relaxant; single dose group, regular dose maintained group, and small dose maintained group. All the patients received the total intravenous anesthesia. The degree of muscle relaxation was observed and the ratio of train of four （TOF） was recorded during surgery. The amplitude and incubation of CMAP were monitored before induction of anesthesia, at 0.5, 1, 1.5 and 2 hours after induction of anesthesia. Results One patient＇s motion occurred in single dose group, whose TOF ratio was zero, patient＇s motion occurred in one case of single dose group. It disappeared after intravenous injection of vecuronium bromide 0. 04 mg/kg and additional propofol 1 mg/kg. No patient＇s motion happened in regular dose maintained group and small dose maintained group. In single dose group and regular dose maintained group, the amplitude and incubation of CMAP at 0,5, 1, 1.5 and 2 hours after induction of anesthesia were significantly different with those before induction of anesthesia （all P〈 0.05）. But there was no significant difference in the amplitude or incubation of CMAP in small dose maintained group before and after induction of anesthesia （all P〉0.05）. Conclusion It is practical to perform the facial nerve monitoring and quantitative muscle relaxation in total intravenous anesthesia. It can provide effective facial nerve monitoring, ensure the success of operation, and avoid damage caused by patient＇s motion during operation.

关 键 词：微血管减压术 面肌痉挛 肌肉松弛药 复合肌肉动作电位 

分 类 号：R614[医药卫生—麻醉学]