不同浓度七氟醚对脊髓手术中躯体感觉诱发电位的影响  

Influence of different sevoflurane concentration on somatosensory evoked potentials monitoring in spinal cord surgery

作　　者：王丽薇[1] 孟秀丽[1] 郭向阳[1] 赵薇[2] 王振宇[2] 

机构地区：[1]北京大学第三医院麻醉科,100191 [2]北京大学第三医院神经外科,100191

出　　处：《中华医学杂志》2015年第10期753-756,共4页National Medical Journal of China

基　　金：国家卫生计生委麻醉学重点专科建设项目

摘　　要：目的 评价七氟醚在不同呼气末浓度下对脊髓手术中躯体感觉诱发电位（SSEPs）监测的影响,探索此类手术应用七氟醚麻醉的可行性,并为临床麻醉用药选择提供依据.方法 选择年龄18 ～65岁,美国麻醉医师协会分级（ASA）Ⅰ～Ⅱ级,需择期行脊髓肿瘤切除手术患者32例.常规麻醉诱导后,对七氟醚呼气末浓度分别为0.0％、0.5％、1.0％、1.5％时的SSEPs波幅和潜伏期进行测量和比较.全麻期间瑞芬太尼的输注速度维持在0.2 μg·kg-1 ·min-,适当调整丙泊酚泵注速度维持脑电双频指数（BIS）在30 ～ 50范围内.结果 七氟醚呈剂量依赖性抑制SSEPs,随着呼气末吸入浓度的增大,双侧SSEPs波幅显著降低,其中左侧各组波幅分别为2.36（0.42 ～9.87）、2.14 （0.52～9.44）、1.94（0.47 ～9.44）、1.64（0.36 ～7.46） μV,差异有统计学意义（F=21.66,P＜0.01）,右侧各组波幅分别为2.71（0.43 ～7.1）、2.73（0.43 ～7.1）、2.34（0.44 ～6.6）、1.64（0.39 ～6.15） μV,差异有统计学意义（F=33.94,P＜0.01）;双侧SSEPs潜伏期显著延长,左侧各组潜伏期分别为（41.48±3.45）、（42.45±3.60）、（43.20±3.42）、（44.38±3.78）ms,差异有统计学意义（F=68.07,P＜0.01）,右侧各组潜伏期分别为（40.65±4.91）、（41.53±4.76）、（42.31±4.93）、（43.39±4.79） ms,差异有统计学意义（F =56.52,P＜0.01）.作为术中动态观察监测,32例患者全部可以在七氟醚吸入麻醉下完成监测.结论 七氟醚可以使SSEPs波幅下降,潜伏期延长,并呈剂量依赖性;SSEPs信号有显著的个体差异;在对需行SSEPs监测手术的麻醉用药进行选择时,应该在测定基础状态SSEPs波幅之后决定是否可以使用七氟醚.Objective To evaluate the effects of different end-tidal concentrations of sevoflurane on somatosensory evoked potentials,to explore the feasibility of sevoflurane applied in such kind of surgery,so as to provide useful information in making anesthesia plan for spinal cord surgery.Methods Thirty-two patients scheduled for spinal cord surgery （ASA Ⅰ-Ⅱ,18-65 years old） were enrolled.After induction of anesthesia,they were assigned to receive sevoflurane anesthesia of increment end-tidal concentration in the sequence of 0.0％,0.5％,1.0％ and 1.5％ respectively,under a background intravenous infusion of propofol and remifentanil.Remifentanil infusion rate was 0.2 μg · kg-1 · min-1,while the propofol infusion rate was adjusted to maintain BIS values within the range of 30-50.The amplitude and latency of each SSEPs were recorded and compared.Results Sevoflurane inhibited SSEPs in a dose-dependent manner,SSEPs amplitude significantly decreased following increased end-tidal sevoflurane concentration.The amplitudes of the left side were 2.36（0.42-9.87）,2.14（0.52-9.44）,1.94（0.47-9.44）,1.64（0.36-7.46） μV respectively（F =21.66,P ＜ 0.01）.The amplitudes of the right side were 2.71 （0.43-7.1）,2.73（0.43-7.1）,2.34（0.44-6.6）,1.64（0.39-6.15） μV respectively（F =33.94,P ＜0.01）.SSEPs latencies were significantly prolonged,on the left side,the latencies were （41.48 ±3.45）,（42.45 ± 3.60）,（43.20 ±3.42）,（44.38 ±3.78） ms,respectively（F =68.07,P ＜0.01）.On the right side,the latencies were （40.65 ±4.91）,（41.53 ±4.76）,（42.31 ±4.93）,（43.39 ±4.79）ms,respectively（F =56.52,P＜0.01）.Yet,as a monitoring modality for dynamic observation,SSEPs still could be monitored successfully under sevoflurane anesthesia in all these 32 patients.Conclusions Sevoflurane has depression effects on SSEPs in a dose-dependent manner.It can decrease the amplitudes and prolong the latencies.Considering significant individual difference,the feasibility of sevof

关 键 词：七氟醚 脊髓手术 躯体感觉诱发电位 

分 类 号：R614[医药卫生—麻醉学]