不同剂量瑞芬太尼联合右美托咪定对颈椎前路手术诱发电位的影响  

Effects of different doses of remifentanil combined with dexmedetomidine on evoked potentials in anterior cervical spine surgery

作　　者：张雪维 孙艳斌[1] 王文玺[1] 王馨[1] 周宏杨 ZHANG Xue-wei;SUN Yan-bin;WANG Wen-xi;WANG Qin;ZHOU Hong-yang(Department of Anesthesiology,Chengde Central Hospital,Chengde HUBEI 067000,China)

机构地区：[1]承德市中心医院麻醉科,河北承德067000

出　　处：《中国新药与临床杂志》2020年第12期731-735,共5页Chinese Journal of New Drugs and Clinical Remedies

基　　金：承德市科学技术研究与发展计划项目(202002A013)。

摘　　要：目的探讨不同剂量瑞芬太尼联合右美托咪定对颈椎前路手术躯体感觉诱发电位(SEP)与运动诱发电位(MEP)的影响。方法选取拟行单节段颈椎前路手术的患者180例,随机分为3组,每组60例。3组均在气管插管前给予右美托咪定1μg·kg^-1泵注,结束后A、B、C组分别按血浆浓度1.5、2.0、2.5μg·L^-1靶控输注瑞芬太尼。记录患者进入手术室时(T0)、气管插管前(T1)、气管导管经过鼻咽部即刻(T2)、气管导管经过声门即刻(T3)、导管套囊充气即刻(T4)及导管进入气管后1 min(T5)的平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(Sp O2)和呼吸频率(RR),以及插管过程中插管反应及呼吸抑制发生情况。测量患者输注瑞芬太尼前(S0)、输注瑞芬太尼后1、5、10、15 min(S1、S2、S3、S4)时SEP和MEP波幅与潜伏期。结果与T0时相比,T2-T4时A组MAP升高,HR增快(P<0.05),而B组和C组MAP、HR无明显变化(P>0.05)。与T0时相比,C组T3-T5时Sp O2降低(P<0.05),T2-T5时RR减慢(P<0.05),T2-T4时A组和B组Sp O2、RR无明显变化(P>0.05)。插管过程中,A组呛咳、体动发生率高于B组和C组(P<0.05),而C组呼吸抑制发生率高于A组和B组(P<0.05)。与S0时相比,S2-S4时C组SEP和MEP潜伏期均延长,波幅均降低,且同观察时点C组SEP和MEP潜伏期长于A组、B组,波幅低于A组、B组(均P<0.05),A组和B组组间比较均无显著差异(P>0.05)。结论颈椎前路手术麻醉中,瑞芬太尼2.0μg·L^-1靶控输注联合右美托咪定可维持血流动力学稳定,减少插管不良反应发生率,且利于术中对SEP和MEP的监测。AIM To investigate the effects of different doses of remifentanil combined with dexmedetomidine on somatosensory evoked potential(SEP) and motor evoked potential (MEP) in anterior cervical spine surgery.METHODS One hundred and eighty patients underwent single-segment cervical anterior surgery were randomly divided into three groups,60 cases in each group.All patients in three groups were given dexmedetomidine 1μg·kg^-1 pump injection before tracheal intubation,then groups A,B,and C were given infusion of remifentanil at a plasma concentration of 1.5,2.0,and 2.5μg·L^-1 respectively.Mean artery pressure (MAP),heart rate (HR),pulse oxygenation saturation (Sp O2) and respiratory rate (RR) were monitored at the time of entering the operating room (T0),before endotracheal intubation (T1),time after endotracheal tube passing through nasopharynx (T2),time after glottis (T3),time after intubation of catheter sleeve (T4) and 1 minute after catheter entering the trachea (T5).Intubation response and respiratory depression during intubation were recorded.The amplitude and latency of SEP and MEP were measured and compared before remifentanil infusion(S0) and 1,5,10 and 15 minutes after remifentanil infusion (S1,S2,S3,S4) in three groups.RESULTS Compared with T0,MAP and HR significantly increased in the group A at T2-T4 (P<0.05),while there was no significant change in the group B and group C(P>0.05).Compared with T0,Sp O2 decreased significantly in the group C at T3-T5 (P<0.05)and RR decreased at T2-T5 (P<0.05),while no significant change in the group B and group C at T2-T4 (P>0.05).During intubation,the incidence of choking and body movement in the group A was higher than that in the group B and group C(P<0.05),while the incidence of respiratory depression in the group C was higher than that in the group A and group B (P<0.05).Compared with the S0,the latency of SEP and MEP at S2-S4 in the group C was significantly prolonged and the amplitude of SEP and MEP was significantly decreased(P<0.05).And at the same time point,th

关 键 词：颈椎 外科手术 瑞芬太尼 右美托咪定 诱发电位 颈椎前路手术 

分 类 号：R971[医药卫生—药品]