不同肌松程度对特发性脊柱侧凸矫形术中经颅电刺激运动诱发电位的影响  

Effects of different levels of neuromuscular blockade on transcranial electric motor-evoked potentials during idiopathic scoliosis

作　　者：刘海雁[1] 赵鑫[1] 钱玥[1] 史本龙 邱俊荫 朱泽章 邱勇 马正良[1] 顾小萍[1] 

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,210008 [2]脊柱外科

出　　处：《中华麻醉学杂志》2017年第3期337-340,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价不同肌松程度对特发性脊柱侧凸矫形术中经颅电刺激运动诱发电位（TCe—MEPs）的影响。方法拟在全麻下行特发性脊柱侧凸矫形手术患者30例，年龄11—23岁，ASA分级I或Ⅱ级，体重31～62kg，性别不限。术中采用四个成串刺激（TOF）模式监测肌松程度，根据TOF比值（TOFR）和TOF反应数将部分肌松程度分为5个状态：TOF反应数1或2（TOF1）、TOF反应数为3且TOFR≤15％（TOF2）、TOFR16％～25％（TOF3）、TOFR26％～50％（TOF4）和TOFR51％～75％（TOF。），TOFR〉75％（无肌松程度）。每个状态维持10min。记录TCeMEPs监测的失败和假阳性情况、术中体动发生情况和肌松满意情况。结果与无肌松程度比较，TOF，、TOF：和TOF，时TCeMEPs监测失败率和假阳性率升高，体动发生率降低，肌松程度满意率升高（P〈0．05），TOF4和TOF5时TCe—MEPs监测失败率和假阳性率差异无统计学意义（P〉0．05），TOF4时体动发生率降低，肌松程度满意率升高，TOF。时肌松程度满意率升高（P〈0．05），体动发生率差异无统计学意义（P〉0．05）。与TOF。时比较，TOF。时TCeMEPs监测失败率和假阳性率差异无统计学意义（P〉0．05），体动发生率升高，肌松程度满意率降低（P〈0．05）。结论术中维持TOFR26％～50％的部分肌松程度不影响特发性脊柱侧凸矫形术中TCeMEPs的监测，同时满足术中肌松要求，是该类手术的适宜肌松程度。Objective To evaluate the effects of different levels of neuromuscular blockade （NMB） on transcranial electric motor-evoked potentials （TCeMEPs） during idiopathic scoliosis. Methods Thirty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 11-23 yr, weighing 31-62 kg, scheduled for elective idiopathic scoliosis under general anesthesia, were enrolled in the study. NMB was monitored with train of four （TOF）-Watch SX. The levels of partial NMB were classified into 5 states according to TOF ratio （TOFR） and TOF counts： 1 or 2 TOF counts （TOF1） , 3 TOF counts and TOFR〈~15% （TOF2） , TOFR 16%-25% （TOF3） , TOFR 26%-50% （TOF4） , TOFR 51%-75% （TOFs） and TOFR〉75% （no NMB）. Each state was maintained for 10 min. Failure and false-positive findings in TCeMEP monitoring, development of unexpected body movement and satisfaction with NMB were recorded. Results Compared with no NMB, the failure and false-positive rates of TCe- MEP monitoring were significantly increased, the incidence of unexpected body movement was decreased, and the rate of satisfactory NMB was increased at TOF1, TOF2 and TOF3 （P〈 0. 05）, no significant change was found in failure or false-positive rates of TCeMEP monitoring at TOF4 and TOF5 （P〉0. 05） , and the incidence of unexpected body movement was decreased and the rate of satisfactory NMB was increased at TOF4, the rate of satisfactory NMB was increased at TOF5 （P〈 0.05） , and no significant change was found in the incidence of unexpected body movement at TOF5 （P〉0.05）. Compared with those at TOF4 , no significant change was found in the failure or false-positive rates of TCeMEP monitoring （P〉 0.05 ） , the incidence of unexpected body movement was significantly increased, and the rate of satisfactory NMB was decreased at TOF5 （P〈0. 05）. Conclusion Maintaining TOFR at 26%-50% the partial NMB during surgery does not affect TCeMEP monitoring during idiopathic scoliosis and meets the i

关 键 词：神经肌肉阻滞 诱发电位 运动 脊柱侧凸 

分 类 号：R614[医药卫生—麻醉学]