不同神经肌肉阻滞程度对神经外科患者术中运动诱发电位监测的影响  

Effects of different degrees of neuromuscular block on intraoperative monitoring of motor evoked potential in patients undergoing neurosurgery

作　　者：王昀 苏怡蝶 钱新烨 王英伟 WANG Yun;SU Yi-die;QIAN Xin-ye;WANG Ying-wei(Dept.of Anesthesiology,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院麻醉科,上海200040

出　　处：《同济大学学报（医学版）》2020年第5期598-603,共6页Journal of Tongji University(Medical Science)

基　　金：上海市科学技术委员会项目(16DZ1911106)。

摘　　要：目的比较不同神经肌肉阻滞程度下的运动诱发电位(motor evoked potential,MEP)变化以及在术中的适用性。方法MEP监测下的180例接受神经外科幕下肿瘤或动脉瘤手术患者,被随机分为A、B、C组,每组60例。A组术中保持四个成串刺激(train of four,TOF)计数为2,B组术中TOF计数为4,但同时需保持T1/Tc比值为0.5,C组为术中无肌松组。记录术中监测MEP的波幅变化,MEP对手术监测的有效性以及患者术中体动、自主呼吸恢复和血流动力学稳定性的影响。结果神经肌肉阻滞药物显著降低MEP的波幅。无肌松组患者MEP波幅无明显变化,术中体动、自主呼吸恢复事件、手术时间较其他组无明显增加(P>0.05)。3组的手术时间、患者的基本特征以及血流动力学参数、术中药物的剂量、术中不良反应差异均无统计学意义(P>0.05)。结论在需要MEP监测的手术患者中,在MEP监测时若使用NMB,则建议将目标设为术中TOF计数为4,但同时需保持T1/Tc比值为0.5。在MEP振幅变化方面,不使用NMB会提供更好的MEP波形以及监测效果。Objective To investigate effects of different degrees of neuromuscular block on intraoperative monitoring of motor evoked potential(MEP)in patients undergoing neurosurgery.Methods One hundred and eighty patients undergoing neurosurgery under MEP monitoring were randomly divided into 3 groups:group A maintained intraoperative train of four stimulations(TOF)with counts of 2,group B maintained intraoperative TOF with counts of 4,and T1/Tc of 0.5,group C was without intramuscular relaxation group.The amplitude of intraoperative monitoring MEP changes,the effectiveness of MEP in surgical monitoring,and the effect of intraoperative body movement,spontaneous breathing recovery,and hemodynamic stability were recorded.Results Neuromuscular blocking drugs significantly reduced the amplitude of MEP.In group C there was no significant change in MEP amplitude(P>0.05);and the intraoperative body movement,spontaneous breath recovery events and operation time were not significantly increased compared with other groups(P>0.05).There was no significant difference in the operation time(P>0.05),the basic characteristics of the patients and the hemodynamic parameters(P>0.05),the dose of intraoperative drugs(P>0.05)and the adverse reactions during the operation(P>0.05)among three groups.Conclusion In neurosurgical patients who need MEP monitoring,if NMB is used during MEP monitoring,it is recommended to set the target T1/Tc to 0.5.In terms of MEP amplitude changes,not using NMB will provide better MEP wave shapes and monitoring effects.

关 键 词：运动诱发电位 神经肌肉阻滞 神经外科手术 顺式阿曲库铵 

分 类 号：R614[医药卫生—麻醉学]