不同剂量肌松剂在听神经瘤术中神经电生理监测及术后并发症的临床观察  

Clinical observation of neuroelectrophysiological monitoring and postoperative complications of different doses of muscle relaxant in the treatment of acoustic neuroma

作　　者：李金峰[1] 王帆[1] 陈金龙[1] 

机构地区：[1]厦门市第三医院麻醉科,福建厦门361100

出　　处：《中国现代医生》2016年第30期110-113,共4页China Modern Doctor

基　　金：福建省厦门市科技局项目(3502Z20164063)

摘　　要：目的探讨不同剂量肌松剂在听神经瘤术中神经电生理监测及术后并发症的临床观察。方法回顾分析听神经瘤术中及术后患者的临床资料,将患者按不同剂量肌松剂分为四组,Ⅰ组为完全停止肌松,Ⅱ组为维持顺阿曲库铵量的1/8,Ⅲ组为维持顺阿曲库铵量的1/4,Ⅳ组为维持顺阿曲库铵量的1/2;记录术中体感诱发电位(somatosensory evoked potential,SEP)、运动诱发电位(motor evoked potential,MEP)及面瘫发生率。结果Ⅰ组、Ⅱ组MEP波幅与潜伏期无明显差异(P>0.05),Ⅰ组、Ⅱ组潜伏期和波幅明显小于Ⅲ组、Ⅳ组(P<0.05);前6个月四组面瘫发生率无明显差异(P>0.05),6个月后,小剂量的肌松组发生面瘫的几率明显小于其他三组(P<0.05);面瘫累计发生例数做拟合优度检验证实小剂量的肌松面瘫将呈平缓趋势,而另外三组呈进行性发展。结论小剂量的肌松剂在神经电生理监测下具有更明显的MEP敏感性,同时改善患者面瘫发生率。Objective To investigate the clinical effects of different doses of muscle relaxants in the detection of intra- operative acoustic neuroma and postoperative complications. Methods The clinical data of patients with acoustic neuroma during and after surgery were retrospectively analyzed. Intraoperative patients who were given different doses of muscle relaxants were divided into four groups： group I was completely stopped muscle relaxation; group II was main- taining 1/8 of the amount of cisatracurium; group Ⅲ was maintaining 1/4 of the amount of cisatracurium; group IV was maintaining 1/2 of the amount of cisatracurium; the somatosensory evoked potential（SEP）, motor evoked potential （MEP） and incidence of facial paralysis were recorded. Results There was no significant difference between MEP amplitude and latency in group I and group II. The amplitude and latency in Grop I and group II were significantly less than those in group III and group IV（P〈0.05）; There was no significant difference in the incidence of facial paralysis between the four groups in the first 6 months（P〉0.05）. After 6 months, the incidence of facial paralysis in the low-dose muscle relaxant group was significantly less than those in the other three groups （P〈0.05）. The cumulative incidence of facial paralysis for the goodness of fit test confirmed that the small dose of muscle relaxant paralysis will show a gentle trend, while the other three groups showed a progressive development. Conclusion Low-dose muscle relaxant has a more pronounced sensitivity to MEP in neuroelectrophysiological examination, and meanwhile improves the incidence of facial paralysis.

关 键 词：肌松 诱发电位 听神经瘤 面瘫 

分 类 号：R614[医药卫生—麻醉学]