不同神经肌肉阻滞程度对经颅电刺激运动诱发电位(MEPs)的影响  

Effects of neuromuscular blockade on transcranial electrical motor evoked potentials (MEPs)

作　　者：李彩霞[1] 徐振东[1] 梁伟民[1,2] 

机构地区：[1]复旦大学附属华山医院麻醉科,上海200040 [2]上海市静安区中心医院麻醉科,上海200040

出　　处：《复旦学报（医学版）》2014年第2期234-237,共4页Fudan University Journal of Medical Sciences

基　　金：上海市卫生局基金面上项目(20124287)~~

摘　　要：目的 比较不同神经肌肉阻滞程度对经颅电刺激运动诱发电位（motor evoked potentials,MEPs）的影响,为术中MEPs监测选择合适的神经肌肉阻滞程度提供依据。方法 选取择期神经外科手术患者20例,年龄22～65岁,ASAⅠ～Ⅱ级。选择拇短展肌作为记录肌肉,采用经颅电刺激技术记录MEPs,刺激参数为：电压300 V,频率1 000 Hz,持续时间75 μs,脉冲数6个/串。采用丙泊酚复合瑞芬太尼全凭静脉麻醉,维库溴铵持续输注维持肌松,分别记录4个成串刺激（train of four stimulations,TOF）为0、1、2和4时的MEPs波幅和潜伏期变化情况。结果 TOF为0～4时均可记录到MEPs波幅。TOF为0与TOF为1、2和4之间的波幅差异均有统计学意义（P均〈0.001）;TOF为1、2和4之间的差异均无统计学意义;MEPs潜伏期变化不显著（F=0.050,P=0.980）。结论 在丙泊酚复合瑞芬太尼全凭静脉麻醉下,神经肌肉阻滞剂对MEPs有显著的抑制作用,MEPs波幅随着神经肌肉阻滞程度的加深而减小,但在较深的神经肌肉阻滞程度下（TOF=1）仍可监测MEPs。Objective To compare the effects of different degrees of neuromuscular blockade on transcranial electrical motor evoked potentials （MEPs）,and determine an appropriate level of neuromuscular blockade during the MEPs monitoring.Methods Twenty patients of ASA Ⅰ-Ⅱ aged 22-65 years undergoing craniotomy were enrolled.Anesthesia was maintained with propofol and remifentanyl.Vecuronium infusion was used to maintain muscular relacation,and the amplitudes and latency of MEPs were recorded train of four stimulations （TOF） was at 0,1,2,4,respectively.MEPs were recorded by transcranial electrostimulation from the abductor pollicis brevis muscle with the impulse of 6 stimulations delivered at 1 000 Hz and 300 V and maintained for 75 μs.The effects of four degrees of neuromuscular blockade on MEPs were studied.Results The MEPs were recorded successfully at TOF=0,1,2 and 4,respectively.The MEPs amplitude at TOF=0 was significantly lower than those at TOF：1,2 and 4 （P〈0.001）,whereas there were no significant differences of MEPs amplitude observed among TOF=1,2 and 4.The latency of MEPs were no significant difference between the 4 degrees of neuromuscular blockade（F=0.050,P=0.980）.Conclusions Neuromuscular blocking agents suppress MEPs significantly during propofol and remifentanyl anesthesia.The MEPs still can be successfully recorded at TOF 1 based on the optimal MEPs monitor method.

关 键 词：运动诱发电位(MEPs) 电刺激 神经肌肉阻滞 

分 类 号：R614.24[医药卫生—麻醉学]