肌松药对面肌痉挛微血管减压术中电生理监测的影响  

Effect of muscle relaxants on lateral spread responses during microvascular decompression for hemifacial spasm

作　　者：卫永旭[1] 杨文磊[1] 赵卫国[1] 李宁[1] 蔡瑜[1] 濮春华[1] 吴哲褒[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院神经外科,上海200025

出　　处：《中国临床神经外科杂志》2015年第9期526-528,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨肌松药对面肌痉挛(HFS)患者微血管减压术(MVD)术中侧方扩散波(LSR)监测的影响。方法将2014年1月至2014年12月进行MVD术中LSR监测的206例HFS病人,依据肌松药使用不同随机分为罗库溴铵(ROC)组(76例)、顺苯磺酸阿曲库铵(CIS)组(69例)和对照组(不使用肌松药,61例),对比分析3组病人LSR诱导成功率、出现时间和波幅大小。结果硬脑膜打开前,对照组LSR诱导成功率为100%,明显高于ROC组(75%;P<0.01)和CIS组(56.5%;P<0.01),而且,后两组间也存在显著差异(P<0.05)。对照组LSR平均出现时间[(3.2±2.5)min]显著短于ROC组[(46.4±20.2)min,P<0.01]和CIS组[(60.9±25.5)min,P<0.01]。对照组LSR波幅亦明显高于ROC组(P<0.05)和CIS组(P<0.05)。此外,与CIS组相比,ROC组LSR出现时间更短(P<0.05),且呈线性关系[LSR出现时间=-10.713+98.342×罗库溴铵(mg/kg),P<0.05]。结论使用肌松药可导致LSR诱导成功率降低、延迟出现和波幅减小,因此,建议在MVD术中行LSR监测时尽量不使用肌松药或仅小剂量(≤0.6mg/kg)使用ROC。Objective To investigate the effect of muscle relaxants on later spread response （LSR） monitored by electrophysiological technique in microvascular decompression （MVD） for hemifacial spasm （HFS）. Methods From January to December 2014, of 206 patients with HFS, who were treated by MVD during which neurophysiological monitoring was performed, 76 received rocuronium （ROC） treatment during anesthesia for endotracheal intubation （ROC group）, 69 cisacurium （CIS） （CIS group） and 61 patients did not receive muscle relaxants treatment [blank control （BC） group]. LSR occurrence rate, induction time and amplitude size were compared among the three groups. Result Before opening dura mater, the LSR occurrence rate in BC group （100%） was significantly higher than those in ROC group （75.0%, 57/76; P〈0.01） and CIS group （39/69, 56.5; P〈0.01）. There was significant difference in LSR occurrence rates between both ROC and CIS groups （P〈0.05）. The LSR induction time [（3.2±2.5）mini was significantly shorter in BC group than that [（46.4±20.2）min] in ROC group （P〈0.01）, which was significantly shorter than that [（60.9±25.5）mini in CIS group （P〈 0.01）. LSR amplitude size was significantly higher in BC group than those in both ROC and CIS groups （P〈0.05）. LSR induction time was positively related to the dose of ROC in ROC group （P〈O.05）. Conclusion Muscle relaxants show an inhibitory effect on LSR occurrence rate, induction time and amplitude size. Therefore, no use of muscle relaxants or use of a small dose of ROC was recommended for an early stable induction of LSR during MVD for HFS.

关 键 词：面肌痉挛 微血管减压术 术中电生理监测 肌松药 侧方扩散反应 

分 类 号：R745.12[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]