无肌松药下不同麻醉诱导方式对甲状腺手术术中喉返神经监测的影响  

Effect of different anesthesia induction without muscle relaxants for intraoperative recurrent laryngeal nerve monitoring during thyroidectomy

作　　者：周莹 马競 李可 陈磊[1] 陆雅媛 张宗泽[1] 彭勉[1] ZHOU Ying;MA Jing;LI Ke;CHEN Lei;LU Yayuan;ZHANG Zongze;PENG Mian(Dept.of Anesthesiology,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China)

机构地区：[1]武汉大学中南医院麻醉科,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2022年第3期440-444,456,共6页Medical Journal of Wuhan University

基　　金：国家自然科学基金(编号:81371195,81870851);武汉市中青年医学骨干人才培养工程项目(2014年);武汉大学中南医院科技创新培育基金(编号:cxpy2017038)。

摘　　要：目的:比较无肌松药下全凭静脉、全凭吸入与静吸复合麻醉诱导对甲状腺手术术中喉返神经监测信号、插管条件、诱导期血流动力学变化等方面的影响,探讨安全有效的神经电生理监测麻醉诱导方案。方法:前瞻性纳入全麻下行甲状腺结节手术患者105例,按随机数字表法将患者随机分为全凭静脉组(I组)、全凭吸入组(V组)和静吸复合组(B组)。于麻醉诱导前静脉输注瑞芬太尼0.3μg/(kg·min),3 min后,I组行丙泊酚靶控输注(TCI),靶浓度3.0~3.5μg/mL;V组经面罩吸入8%七氟醚;B组行丙泊酚TCI输注,靶浓度1~1.5μg/mL,同时面罩吸入七氟烷3.0%~3.5%。患者脑电双频指数(BIS)达40~50并稳定1 min时,经可视喉镜引导下插入喉返神经监测导管。术中静脉输注丙泊酚和瑞芬太尼予以维持。记录患者插管成功率、插管条件、诱导期间血流动力学变化、术中行喉返神经监测时双向肌电波(EMG)振幅及术后咽痛发生率。结果:经剔除标准剔除2例后,共103例患者完成研究。三组患者插管成功率为100%,三组间插管条件评级、诱导期间的平均动脉压、心率和BIS变化、术后咽痛发生率差异无统计学意义(P>0.05);与I组比较,V组首次神经探查时EMG振幅减弱(P<0.05),B组各时点EMG振幅变化差异均无统计学意义(P>0.05)。结论:瑞芬太尼0.3μg/(kg·min)持续输注联合丙泊酚TCI给药3.0~3.5μg/mL为术中神经监测下甲状腺手术理想的麻醉诱导方式。Objective: To compare the effects of total intravenous anesthesia, total inhalation anesthesia,and balanced anesthesia induction without muscular relaxants on intraoperative recurrent laryngeal nerve monitoring, intubation conditions, and changes of haemodynamics during thyroidectomy.Methods: One hundred and five patients undergoing selective thyroidectomy were randomized into total intravenous aneshtesia group(group I), total inhalation group(group V), and balanced anesthesia group(group B). All patients were injected with remifentanil 0. 3 μg/(kg·min) for 3 min, then patients in group I were treated with target-controlled infusion(TCI) of propofol with the target concentration at 3. 0-3. 5 μg/mL, patients in group V were treated with mask inhalation of 8% sevoflurane, and patients in group B were treated with TCI of propofol with the target concentration at 1-1. 5 μg/mL combined with inhalation of 3. 0%-3. 5% sevoflurane for group B. When EEG bispectral index(BIS) value was achieved and stayed at 40-50, intubation was performed. Anesthesia was maintained by TCI of propofol and remifentanil for all the patients. Successful intubation rate, grades of intubating condition, haemodynamic changes during anesthesia induction, amplitude of electromyography(EMG) signal of intraoperative recurrent laryngeal nerve monitoring, and postoperative pharyngodnia rates were recorded. Results: The rates of successful intubation, grades of intubating condition, haemodynamic changes during anesthesia induction had no difference among three groups. Compared with that in group I, amplitudes of EMG signal were decreased when first stimulated vagal nerve and recurrent laryngeal nerve in group V(P<0. 05). No difference was found in the amplitudes of EMG signal between group I and group B. The rates of successful intubation, grades of intubating condition, and haemodynamic changes during anesthesia induction had no difference among three groups. Conclusion:Remifentanil 0. 3 μg/(kg·min) combined with TCI of propofol at target concen

关 键 词：术中神经监测 甲状腺手术 喉返神经 插管条件 

分 类 号：R34[医药卫生—基础医学]