右美托咪啶用于神经肿瘤手术运动诱发电位监测期的临床观察  

Clinical observation on application of dexmedetomidine during motor evoked potentials monitoring period in patients undergoing neural tumor surgery

作　　者：王静静[1] 戴寒英[2] WANG Jingjing;DAI Hanying(Department of Anesthesiology,First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230022,China;Department of Anesthesiology,First Affiliated Hospital of Nanchang University,Nanchang,Jiangxi 330006,China)

机构地区：[1]安徽医科大学第一附属医院麻醉科,合肥230022 [2]南昌大学第一附属医院麻醉科,330006

出　　处：《重庆医学》2021年第10期1688-1692,共5页Chongqing medicine

基　　金：江西省教育厅科学技术研究项目(GJJ2080)。

摘　　要：目的探讨在神经肿瘤手术运动诱发电位(MEP)监测期无负荷剂量持续输注右美托咪啶(DEX)的临床效果。方法选择行MEP监测的神经外科颅脑肿瘤切除手术患者80例,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级,将其分为4组:N组(不使用DEX)、D1组(诱导前负荷剂量0.50μg/kg+维持量0.50μg·kg^(-1)·h^(-1)至监测期结束)、D2组(监测期负荷剂量0.50μg/kg+维持量0.50μg·kg^(-1)·h^(-1)至监测期结束)、D3组(监测期维持量0.50μg·kg^(-1)·h^(-1)),每组20例。观察患者入室(T0)、切皮(T1)、停肌松药时(T2),停肌松药15 min后(T3)、60 min后(T4),电生理实验结束时(T5)的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、脑电双频指数(BIS)水平;MEP监测质量,麻醉维持期丙泊酚的使用剂量;患者麻醉恢复指标,拔管1 h后的Ramsay镇静评分(RSS)、视觉模拟评分(VAS)及不良事件发生情况。结果与T0比较,N组T1~5时HR增快、MAP升高(P<0.05),D2、D3组T1~2时HR增快、MAP升高(P<0.05);N组T1~5时HR、MAP高于D1组,T3~5时HR、MAP高于D2、D3组(P<0.05);D1组T1~2 HR、MAP低于D2、D3组(P<0.05);D2组T3~5时HR、MAP低于D3组(P<0.05)。首次诱发MEP的电流强度N组最高,D3组低于D2组(P<0.05);T4时大鱼际肌MEP波幅N组最低,D3组高于D2组(P<0.05);麻醉维持期N组丙泊酚用量较高,D3组高于D1组(P<0.05)。D1组麻醉恢复时间最长(P<0.05);拔管1 h后N组VAS高于D1、D2、D3组(P<0.05),而RSS低于D1组(P<0.05)。D1组心动过缓的发生率高于N组(P<0.05),低血压的发生率高于N、D3组(P<0.05)。结论神经肿瘤手术MEP监测期无负荷剂量持续静脉泵注DEX(0.50μg·kg^(-1)·h^(-1)),可提高神经电生理监测质量,降低不良事件的发生率,是一种更精准、安全的麻醉方法。Objective To observe the clinical effect of continuous infusion of dexmedetomidine(DEX)with the no-load dose during the period of monitoring extra-surgical motor evoked potentials(MEP)in neural tumor surgery.Methods Eighty patients with craniocerebral tumor resection receiving MEP monitoring,ASAⅠ-Ⅱ,were selected and divided into 4 groups:group N(did not use DEX),group D1(load dose 0.50μg/kg+maintenance dose 0.50μg·kg^(-1)·h^(-1)before anesthesia induction until the end of monitoring period),group D2(load dose 0.50μg/kg+0.50μg·kg^(-1)·h^(-1)maintenance dose 0.50μg·kg^(-1)·h^(-1)from the monitoring period until the monitoring end),group D3(maintenance dose 0.50μg·kg^(-1)·h^(-1)during MEP monitoring period),20 cases in each group.The levels of HR,MAP,SPO2 and BIS were observed at entering into the operating room(T0),skin incision(T1),stopping the muscle relaxants(T2),at 15 min after stopping the muscle relaxants(T3),at 60 min after stopping the muscle relaxants(T4)and at the end of electrophysiological experiment(T5).MEP monitored the quality and the propofol use dose during anesthesia maintenance period.The anesthetic recovery indicators,Ramsay score at 1 h after extubation,VAS score and the occurrence of adverse events were also recorded.Results Compared with T0,HR and MAP at T1-5 in the group N were increased(P<0.05),and HR and MAP at T1-2 in the group D2 and D3 were increased(P<0.05).HR and MAP at T1-5in the group N were higher than those in the group D1,which at T3-5 were higher than those in the group D2 and D3(P<0.05).HR and MAP at T1-2 in the group D1 were lower than those in the group D2 and group D3(P<0.05).HR and MAP at T3-5 in the group D2 were lower than those in the group D3(P<0.05).The current intensity of the first induced MEP was highest in the group N and the group D3 was lower than the group D2(P<0.05);the thenar muscles MEP amplitude at T4 was lowest in the group N,the group D3 was higher than the group D2(P<0.05);the propofol dosage during the maintenance period in the group N

关 键 词：右美托咪啶 神经外科手术 运动诱发电位 监测期 负荷剂量 

分 类 号：R459.9[医药卫生—治疗学]