七氟烷联合TOF监测在面神经微血管减压术中的应用  

Application of sevoflurane combined with TOF monitoring in facial nerve microvascular decompression

作　　者：石先俊 高骏 谭宇亭 肖程 侯智 景胜 SHI Xian-jun;GAO Jun;TAN Yu-ting;XIAO Cheng;HOU Zhi;JING Sheng(Department of Neurosurgery,Second Affiliated Hospital of Army Medical University,Chongqing 400037,China;Department of Anesthesiology,Second Affiliated Hospital of Army Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院神经外科,重庆400037 [2]陆军军医大学第二附属医院麻醉科,重庆400037

出　　处：《局解手术学杂志》2023年第3期225-229,共5页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨面神经微血管减压术中七氟烷联合神经电生理四个成串刺激(TOF)监测的麻醉方案。方法纳入我院行微血管减压手术的77例面肌痉挛患者,依据七氟烷的使用情况将患者分为3组:A组全程使用七氟烷(n=25),B组不使用七氟烷(n=22),C组当TOF值≥50%后联合使用七氟烷(n=30)。比较各组血流动力学变化和体动、呛咳情况,记录各组患者TOF值恢复所需要的时间,及患者切开硬脑膜前侧方扩散反应(LSR)引出率和波幅。探讨TOF值与LSR波幅的关系。结果A组、C组患者术中均未出现体动及呛咳,B组中2例患者出现轻微体动。各组T1~T6时的心率和收缩压比较,均无显著性差异(P>0.05);B组的心率、收缩压变异系数与A组、C组比较均有显著性差异(P<0.001)。B组、C组TOF值恢复时间较A组短(P<0.001);B组、C组最早引出LSR所需时间较A组短(P<0.05)。LSR平均波幅随TOF值的恢复逐渐增高(P<0.001),当TOF值达到80%~89%后波幅增加不显著(P>0.05);B组、C组所有患者能在切开硬脑膜前建立LSR监测的准确基线,而A组只有76%的患者可实现。结论在微血管减压术中使用低剂量(0.6 mg/kg)的罗库溴铵诱导麻醉,且在TOF值恢复到50%及以上复合1%~2%的七氟烷,可能是MVD理想的麻醉方式,既能获得满意的麻醉效果又能保证LSR监测的准确性。Objective To investigate the anesthetic protocol of sevoflurane combined with neuroelectrophysiological train of four stimulation(TOF)monitoring in facial nerve microvascular decompression(MVD).Methods A total of 77 patients with hemifacial spasm who underwent MVD in our hospital were included and divided into three groups according to the use of sevoflurane,among which patients in the group A(n=25)used sevoflurane during the whole process,patients in the group B(n=22)did not use sevoflurane and patients in the group C(n=30)used sevoflurane when TOF value≥50%.The hemodynamic change,body movement and choking were compared among the groups,and the time of TOF recovery for patients in each group,as well as the elicitation rate of lateral spread response(LSR)and amplitude before dural incision were recorded.The relationship between TOF value and LSR amplitude was investigated.Results There was no body movement or choking occurred during operation in the group A and the group C,while 2 patients in the group B had slight body movements.There was no statistically significant difference in heart rate or systolic blood pressure from T1 to T6 among groups(P>0.05),the variation coefficients of heart rate and systolic blood pressure in the group B were significantly different from those in the group A and the group C(P<0.001).The recovery time of TOF values in the group B and the group C was significantly shorter than that in the group A(P<0.001),and the earliest time for eliciting LSR in the group B and the group C was significantly shorter than that in the group A(P<0.05).The mean amplitude of LSR increased gradually with the recovery of TOF values(P<0.001),but its incerase was not significant when TOF values reached 80%to 89%(P>0.05).The patients in both the group B and the group C could established accurate baselines of LSR monitoring before dural incision,while only 76%of patients in the group A could established it.Conclusion A low dose(0.6 mg/kg)of rocuronium for anesthesia induction combined with 1%to 2%sevoflurane

关 键 词：七氟烷 TOF监测 面肌痉挛 微血管减压 侧方扩散反应 

分 类 号：R614.2[医药卫生—麻醉学]