不同剂量右美托咪定对SEP联合MEP监测神经外科手术患者的影响  

Effects of different doses of dexmedetomidine used in SEP and MEP monitoring in patients undergoing neurosurgery

作　　者：郭余大 戴寒英[2] 陈立科[3] 文婷[2] 戴祺[2] 

机构地区：[1]宁波市第二医院麻醉科,宁波市315010 [2]南昌大学第一附属医院麻醉科,南昌市330006 [3]南昌大学第一附属医院神经外科,南昌市330006

出　　处：《实用医学杂志》2017年第10期1669-1673,共5页The Journal of Practical Medicine

基　　金：江西省教育厅科学技术研究项目(编号:GJJ12080)

摘　　要：目的:探讨不同剂量右美托咪定对体感诱发电位(SEP)联合运动诱发电位(MEP)监测神经外科手术患者的影响。方法:择期需做SEP联合MEP监测脑肿瘤切除术患者80例,随机分为四组:C组、D_1组、D_2组和D_3组。麻醉诱导前D_1组、D_2组和D_3组经静脉10 min输注右美托咪定0.5μg/kg,后以右美托咪定0.1、0.3μg/(kg·h)和0.5μg/(kg·h)维持至术毕,C组采取同样方法予以等容量生理盐水。于入室时(T_1),切皮时(T_2),停肌松药时(T_3),停肌松药后50 min(T4)观察MAP、HR和BIS值;记录初次诱发MEP的电流强度和监测等待时间,T4时SEP(N20-P25,N20)及大鱼际肌MEP波幅和潜伏期;同时记录术中丙泊酚用量和不良反应发生情况。结果:T_2~T_4时D_2组和D_3组HR明显慢于、MAP明显低于C组和D_1组(P<0.05)。D_2组和D3组丙泊酚用量明显低于C组和D_1组;D_2组诱发MEP的电流强度明显低于C组、D_1组和D_3组,D_3组明显低于C组;T_4时D_2组MEP波幅明显高于C组、D_1组和D_3组,D_3组明显高于C组(P<0.05)。四组患者其余指标差异无统计学意义(P>0.05)。结论:麻醉诱导前静脉输注右美托咪定0.5μg/kg后以右美托咪定0.3μg/(kg·h)维持,能够降低丙泊酚用量间接改善MEP监测质量,对MEP抑制作用更小,对SEP无明显影响,且血流动力学稳定。Objective To investigate the effects of different doses of dexmedetomidine used in SEP and MEP monitoring in patients undergoing neurosurgery. Methods Eighty patients undergoing neurosurgery receiving SEP and MEP monitoring were randomly divided into 4 groups （n = 20 each） ： group C, group D1, group D2 and group D3. In groups D1, D2 and D3, dexmedetomidine 0.5 μg/kg was infused over 10 minutes before anesthesia induction, and then was infused at a rate of 0.1, 0.3 and 0.5 μg/（kg· h） respectively toward the end of operation. Group C received the equal volume of normal saline. HR , MAP and BIS were recorded at admission to the operating room （T1） , skin incision （T2） , when the muscle relaxants were stopped （%） and 50 minutes later （T4）. The current intensity and the time when first MEP was induced after muscle relaxant was stopped, the amplitudes and latencies of SEP （N20-P25, N20） and MEP on thenar muscle at T4, the total consumption of propofol, and development of adverse affects were also recorded. Results Compared with groups C and D1, HR and MAP were decreased at T2-T4 in groups D2 and D3（P 〈 0.05）. The amount of propofol consumed were lower in groups D2 and D3 than in groups C and D1 （P 〈 0.05 ）. The current intensity inducing MEP was lower and the amplitude of MEP at T4 was higher in group D2 than in groups C, D1 and D3, and the situation was same in group D3 than in group C （P〈0.05）. No significant change was found in the other parameters in groups C, D,, D2 and D3 （P〉0.05）. Conclusion Dexmedetomidine infused at 0.3 μg/（ kg · h ） after infusion of a loading dose of 0.5 μ g/kg could improve monitoring quality of MEP through reducing the amount of propofol consumed, have less inhibition on MEP than other groups, have no obvious effects on SEP, andmaintain hemodynamic stability.

关 键 词：右美托咪定 体感诱发电位 运动诱发电位 脑肿瘤 

分 类 号：R614[医药卫生—麻醉学] R739.41[医药卫生—外科学]