静吸复合全身麻醉下肌松阻滞水平对常见腰椎手术中SEP及MEP的影响  

Effect of muscle relaxation block level under intravenous inhalation combined with general anesthesia on sep and MEP in common lumbar surgery

作　　者：谭海涛[1] 陈涛 林友才[2] 黎坚[1] 王挺锐[1] 唐松杰 TAN Hai-tao;CHEN Tao;LIN You-cai(Department of Spinal Surgery,the First Affiliated Hospital of Hainan Medical College,Haikou Hainan 570102,China;Department of Anesthesiology,the First Affiliated Hospital of Hainan Medical College,Haikou Hainan 570102,China)

机构地区：[1]海南医学院第一附属医院脊柱外科,海南海口570102 [2]海南医学院第一附属医院麻醉科,海南海口570102

出　　处：《临床和实验医学杂志》2022年第17期1897-1901,共5页Journal of Clinical and Experimental Medicine

基　　金：海南省卫生健康委课题(编号:20A200222)。

摘　　要：目的探讨静吸复合全身麻醉下肌松阻滞水平对常见腰椎手术术中体感诱发电位(SEP)及运动诱发电位(MEP)的影响。方法采用回顾性研究,选取2019年4月至2020年12月在海南医学院第一附属医院行常规腰椎手术患者100例,根据TOF-Watch SX加速度仪测定的T1作为分组标准,Ⅰ组(T1为0~10%)、Ⅱ组(T1为10%~20%)、Ⅲ组(T1为20%~30%)、Ⅳ组(T1为30%~40%)和V组(T1为40%~50%),每组患者20例。观察各组血流动力学指标、SEP参数、MEP参数等差异,以及剧烈体动发生率、手术时间、手术结束至拔管时间、住院时间资料。结果Ⅰ组和Ⅱ组T1时心率、平均动脉压(MAP)明显低于Ⅲ、Ⅳ、Ⅴ组,差异均有统计学意义(P<0.05);Ⅰ组和Ⅱ组不同时间点心率、MAP比较,差异均无统计学意义(P>0.05);Ⅰ、Ⅱ、Ⅲ、Ⅳ和Ⅴ组不同时间点脑电双频指数(BIS)、血氧饱和度(SpO 2)比较,差异均无统计学新意义(P>0.05)。Ⅰ、Ⅱ、Ⅲ、Ⅳ和Ⅴ组SEP潜伏期和波幅基础值、T2时SEP潜伏期和波幅比较,差异均无统计学意义(P>0.05)。Ⅰ、Ⅱ、Ⅲ、Ⅳ和Ⅴ组T2时MEP波幅明显低于MEP波幅基础值,差异均有统计学意义(P<0.05);Ⅰ组T2时MEP波幅明显低于Ⅱ、Ⅲ、Ⅳ和Ⅴ组,差异均有统计学意义(P<0.05);Ⅰ、Ⅱ、Ⅲ、Ⅳ和Ⅴ组MEP潜伏期基础值、T2时MEP潜伏期比较,差异均无统计学意义(P>0.05)。Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ组剧烈体动发生率分别为5.00%、5.00%、20.00%、40.00%、45.00%,Ⅰ组、Ⅱ组剧烈体动发生率明显低于Ⅳ组和Ⅴ组,差异均有统计学意义(P<0.05)。Ⅰ、Ⅱ、Ⅲ、Ⅳ和Ⅴ组手术时间、手术结束至拔管时间、住院时间比较,差异均无统计学意义(P>0.05)。结论静吸复合全身麻醉下肌松阻滞在腰椎手术中,若T1在10%~20%基础值的肌松水平则有利于患者血流动力学稳定,对神经电生理监测影响小。Objective To investigate the effect of muscle relaxation block level under intravenous inhalation combined with general anesthesia on somatosensory evoked potential(SEP)and motor evoked potential(MEP)during common lumbar surgery.Methods Using a retrospective study,a total of 100 patients who underwent routine lumbar surgery in the First Affiliated Hospital of Hainan Medical College from April 2019 to December 2020 were selected,according to T1 measured by TOF watch SX accelerometer as grouping standard,Group I(T1:0-10%),groupⅡ(T1:10%-20%),groupⅢ(T1:20%-30%),groupⅣ(T1:30%-40%)and group V(T1:40%-50%),there were 20 patients in each group,the differences of hemodynamic indexes,SEP parameters and MEP parameters,and the incidence of strenuous physical activity,operation time,time from operation end to extubation,and hospitalization stay were observed.Results The heart rate and mean arterial pressure(MAP)at T1 in groupⅠand groupⅡwere significantly lower than those in groupⅢ,groupⅣand groupⅤ,the differences were statistically significant(P<0.05).There were no significant differences in heart rate and MAP between groupⅠand group II at different time points(P>0.05).There was no significant difference in bispectral index(BIS)and blood oxygen saturation(SpO 2)between groupsⅠ,Ⅱ,Ⅲ,ⅣandⅤat different time points(P>0.05).There were no significant differences in SEP latency and amplitude basic value,SEP latency and amplitude at T2 between groupⅠ,groupⅡ,groupⅢ,groupⅣand groupⅤ(P>0.05).The amplitude of MEP at T2 in groupⅠ,groupⅡ,groupⅢⅢ,groupⅣand groupⅤwere significantly lower than those of the basic value of MEP amplitude,the differences were statistically significant(P<0.05).The amplitude of MEP at T2 in groupⅠwas significantly lower than that in groupⅡ,Ⅲ,ⅣandⅤ,the difference was statistically significant(P<0.05).There were no significant differences in the basic value of MEP latency and MEP latency at T2 between groupsⅠ,Ⅱ,Ⅲ,ⅣandⅤ(P>0.05).The incidence rates of

关 键 词：静吸复合全身麻醉 肌松阻滞 腰椎手术 体感诱发电位 运动诱发电位 

分 类 号：R614[医药卫生—麻醉学]