全凭静脉麻醉与吸入麻醉对甲状腺手术喉返神经监测的影响  

Influence of Total Intravenous Anesthesia and Inhalational Anesthesia on Intraoperative Recurrent Laryngeal Nerve Monitoring in the Patients undergoing thyroidectomy

作　　者：张国华[1] 王健[2] 倪松[2] 刘绍严[2] 

机构地区：[1]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院麻醉科,北京100021 [2]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院头颈外科,北京100021

出　　处：《医学研究杂志》2017年第6期71-74,19,共5页Journal of Medical Research

基　　金：肿瘤医学协同创新中心基金资助项目(ncc2015xc-08);中国癌症基金会北京希望马拉松专项基金资助项目(LC2015L25)

摘　　要：目的探讨全凭静脉麻醉和吸入麻醉对甲状腺手术喉返神经功能监测的影响。方法 50例ASAⅠ~Ⅱ级、年龄18~60岁、拟行甲状腺癌根治术的女性患者随机平均分为两组:全凭静脉麻醉组(P组)和吸入麻醉组(S组)。P组和S组麻醉维持分别采用异丙酚复合瑞芬太尼和七氟烷复合芬太尼。术中以肌颤搐(TW)恢复的比值(%)来监测肌肉松弛程度(0%TW代表完全肌肉松弛)。记录两组患者0%TW的持续时间(T_0)以及恢复至5%TW、10%TW、20%TW和30%TW的时间(T_5、T_(10)、T_(20)、T_(30)),在上述肌肉松弛条件下的喉返神经监测指标(EMG0、EMG5、EMG10、EMG20、EMG30)。记录两组患者术中出现体动反应的人数以及血流动力学变化情况。结果 P组患者的T_0、T_5、T_(10)、T_(20)和T_(30)均明显短于S组(P<0.05)。喉返神经监测指标在两组差异无统计学意义(P>0.05)。P组患者首次诱发出喉返神经监测肌电信号的时间(35.6±4.7min)明显早于S组(44.4±4.5min)(P<0.05)。P组患者的体动反应人数(2名)明显少于S组(9名)(P<0.05)。P组患者的收缩压最高值(147.3±11.8mm Hg,1mm Hg=0.133k Pa)和最大上升幅度(12.5%±8.6%)亦明显低于S组(157.2±10.9mm Hg、18.0%±9.4%)(P<0.05)。结论与吸入麻醉相比较,全凭静脉麻醉有利于更早地获得喉返神经监测肌电信号,而且血流动力学相对平稳、患者体动反应少,更适合于喉返神经监测手术的麻醉。Objective To investigate the influence of total intravenous anesthesia （TIVA） with propofol plus remifentanil and inha- lational anesthesia with sevoflurane plus fentanyl on intraoperative recurrent laryngeal nerve （RLN） monitoring. Methods Fifty female patients, ASA I - II ,aged between 18 -60 year,scheduled for elective thyroidectomy were randomly allocated into two groups： Group P and Group S. Anesthesia was maintained with TIVA or inhalational anesthetics in Groups P and S, respectively. Rocuronium 0.6mg/kg was given to facilitate the electromyographic （EMG） endotracheal tube insertion. Rocuronium was not added during operation. Bispectral index （BIS） was used to monitor anesthesia depth and kept between 40 -50 during operation. Aecelerometry （% TW） was applied for monitoring neuromuscular transmission of the thumb. 0% TW corresponds to complete muscular blockade. Duration of 0% TW （ To ） and recovery time from 0% TW to 5% TW（ T5 ）, 10% TW（ T10 ） ,20% TW（ T20 ） and 30% TW（ T30 ） were recorded, respectively. The time in- terval from 0% TW to initial successful elicitation of EMG signals was measured in both groups. EMG signals were obtained under 0% TW （EMG0） ,5% TW （ EMG5 ） , 10% TW （EMG10） ,20% TW （EMG20） ,30% TW （EMG30）. The numbers of patients experiencing invol- untary body movement, coughing and swallowing were noted in the two groups. Hemodynamic changes were also observed. Results To , T5 ,T10 ,T20 and T30 were significantly shorter in Group P than in Group S （P 〈 0.05 ）. EMG signals cannot be successfully elicited until the degree of neuromuscular blockade recovered to 10% TW in all patients. The patients in Group p required less time for EMG signals to be initially elicited compared with Group S（35.6 ±4.7min vs 44.4 ± 4.5min） （ P 〈 0.05 ）. Involuntary body movement, coughing and swallowing were more likely to occur in Group P（ in 2 patients） than in Group S（ in 9 patients） （P 〈 0.05）. Both the maximum systol

关 键 词：喉返神经监测 肌电信号 神经肌肉阻滞 全凭静脉麻醉 吸入麻醉 

分 类 号：R4[医药卫生—临床医学]