不同浓度七氟烷麻醉与不同刺激电压对脊髓手术中运动诱发电位波幅和潜伏期的影响  

Influence of sevoflurane concentration and stimulation voltage on motor evoked potentials in intraspinal tumor 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,北京100191 [2]北京大学第三医院神经外科,北京100191

出　　处：《北京大学学报（医学版）》2016年第2期297-303,共7页Journal of Peking University:Health Sciences

摘　　要：目的：评价七氟烷在不同呼气末浓度和不同刺激电压时对脊髓手术中运动诱发电位（motor evoked potentials,MEPs）监测的影响,为临床需要进行MEPs监测手术的麻醉用药提供选择依据。方法：选择年龄18-65岁、ASAⅠ-Ⅱ级、需择期行胸腰段脊髓肿瘤切除手术的患者48例。常规全身麻醉（全麻）诱导后,在手术重要操作步骤开始前分别测定刺激电压为300 V、400 V、500 V、600 V时和七氟烷呼气末浓度分别为0.0%、0.5%、1.0%、1.5%时的MEPs波幅和潜伏期。全麻期间瑞芬太尼的输注速度维持在0.2μg/（kg·min）,适当调整丙泊酚泵注速度维持脑电双频谱指数（bispectral index,BIS）在30-50范围内。结果：七氟烷呼气末浓度和电生理监测仪的刺激电压显著影响MEPs的波幅,在同一刺激电压下,随七氟烷呼气末浓度的提高,MEPs的波幅下降,呼气末浓度1.5%时MEPs波幅（左侧20.50μV、70.71μV、135.97μV、190.00μV,右侧14.29μV、50.71μV、73.10μV、77.50μV）明显低于呼气末浓度0.5%时MEPs波幅（左侧100.00μV、362.57μV、444.05μV、435.00μV,右侧115.00μV、207.15μV、258.34μV、358.50μV）以及0.0%时MEPs波幅（左侧143.00μV、388.10μV、484.53μV、500.00μV,右侧176.00μV、407.60μV、384.35μV、451.00μV）,差异有统计学意义（左侧χ^2=27.46,P〈0.01,右侧χ^2=60.49,P〈0.01;左侧χ^2=20.73,P〈0.01,右侧χ^2=55.05,P〈0.01;左侧χ^2=34.25,P〈0.01,右侧χ^2=33.58,P〈0.01;左侧χ^2=28.61,P〈0.01,右侧χ^2=49.04,P〈0.01）;MEPs的潜伏期也有延长,但结果差异无统计学意义（P=0.26）。同一呼气末浓度下,随刺激电压的增大,MEPs波幅增高,电压300 V时MEPs波幅（左侧143.00μV、100.00μV、61.50μV、20.50μV,右侧176.00μV、115.00μV、41.07μV、14.29μV）明显低于400 V时MEPs波幅（左侧388.10μV、362.57μV、198.81μV、70.71μV,右侧407.60μV、207.15μV、89.00μV、50.71μV）、500 V时MEPs波幅（左侧484.53μV、444.05μV、216.24Objective： To evaluate the effects of increasing end-tidal concentrations of sevoflurane and increasing stimulation voltage on motor evoked potentials,so as to provide evidence in making anesthesia plan for intraspinal tumor surgery. Methods： In the study,48 patients scheduled to undergo intraspinal tumor surgery [American Society of Anesthesiology,（ ASA） Ⅰ- Ⅱ,18- 65 years old] were enrolled.After general anesthesia induction,the patients were assigned to receive sevoflurane anesthesia of increasing end-tidal concentration in the sequence of 0. 0%,0. 5%,1. 0% and 1. 5% respectively,under a background of propofol and remifentanil. All the observations were done before the important steps of surgery. Remifentanil infusion rate was 0. 2 μg /（ kg·min）,while the propofol infusion rate was adjusted to maintain the bispectral index values within the range of 30- 50. At each concentration,4 stimulation voltages of 300 V,400 V,500 V and 600 V were employed to elicit motor evoked potentials（ MEPs）.The amplitude and latency of each MEP were compared. The success ratio was also recorded. Results：The concentration of sevoflurane and the stimulation voltage had impacts on the amplitude and latency of MEPs. Under each stimulation voltage,the MEPs amplitude decreased following increasing end-tidal sevoflurane concentrations,and significant differences were found in comparing 1. 5% sevoflurane（ left20. 50 μV,70. 71 μV,135. 97 μV,190. 00 μV,right 14. 29 μV,50. 71 μV,73. 10 μV,77. 50 μV）with 0. 0% sevoflurane（ left 143. 00 μV,388. 10 μV,484. 53 μV,500. 00 μV,right 176. 00 μV,407. 60 μV,384. 35 μV,451. 00 μV） and 0. 5% sevoflurane（ left 100. 00 μV,362. 57 μV,444. 05μV,435. 00 μV,right 115. 00 μV,207. 15 μV,258. 34 μV,358. 50 μV）,left χ^2= 27. 46,P〈0. 01,right χ^2= 60. 49,P〈0. 01; left χ^2= 20. 73,P〈0. 01,right χ^2= 55. 05,P〈0. 01; left χ^2=34. 25,P〈0. 01,right χ^2= 33. 58,P〈0. 01; left χ^2= 28. 61,P〈0. 01,right χ2= 49. 04,P〈0. 01;while there were no

关 键 词：诱发电位 运动 七氟醚 脊髓 外科手术 麻醉 吸入 

分 类 号：R614.21[医药卫生—麻醉学]