无肌松药条件下气管插管后即刻监测运动诱发电位基线在腰椎手术中的应用  

Feasibility of monitoring the baseline of motor evoked potentials immediately after tracheal intubation with⁃out muscle relaxants in lumbar spine surgery

作　　者：郑伟[1] 李娜[1] 刘磊[2] 刘松涛[1] 周海[1] 刘杰 胡正权[1] 王立伟[1] ZHENG Wei;LI Na;LIU Lei;LIU Songtao;ZHOU Hai;LIU Jie;HU Zhengquan;WANG Liwei(Department of Anesthesiology,Xuzhou Central Hospital,Xuzhou 221009,China;不详)

机构地区：[1]徐州市中心医院麻醉科,江苏徐州221009 [2]徐州市中心医院脊柱外科,江苏徐州221009

出　　处：《实用医学杂志》2024年第16期2298-2304,共7页The Journal of Practical Medicine

基　　金：国家自然科学基金项目(编号:82071903);徐州市科技局医药卫生面上项目(编号:KC23177)。

摘　　要：目的探讨腰椎手术在无肌松药气管插管后即刻监测运动诱发电位(TceMEP)基线的可行性。方法将2023年5-12月在徐州市中心医院拟行经椎间孔入路腰椎椎体间融合术(TLIF)的患者156例随机分为两组,最终对照组72例,男33例,女39例,观察组75例,男37例,女38例,对照组在术中脊柱暴露完成后监测TceMEP基线,观察组在无肌松药气管插管后即刻监测TceMEP基线。对比两组患者气管插管前后血流动力学变化、插管满意度和操作时间,并比较两组TceMEP基线引出成功率、刺激阈值、敏感性和特异性。结果两组患者气管插管时血流动力学变化与插管满意度差异无统计学意义(P>0.05),插管时间对照组为(6.52±1.22)min,观察组为(9.44±0.84)min,两组差异有统计学意义(P<0.05)。观察组TceMEP基线引出成功率为100%,平均刺激阈值(225.00±22.13)V,对照组TceMEP基线引出成功率为84.72%,平均刺激阈值(342.01±31.07)V,两组差异有统计学意义(P<0.05)。对照组在上钉后监测TceMEP成功率为93.06%,观察组为100%,两组差异有统计学意义(P<0.05)。两组TceMEP的敏感度和特异度差异无统计学意义(P>0.05)。结论无肌松气管插管后即刻监测TceMEP基线成功率高,刺激阈值小,敏感性与特异性与术中脊柱暴露完成后监测TceMEP基线无差别。Objective To investigate the feasibility of monitoring the baseline of motor evoked potentials immediately following tracheal intubation without the administration of muscle relaxants in lumbar spine surgery.Methods A prospective study was conducted at Xuzhou Central Hospital,involving a total of 156 patients who were scheduled for Transforaminal Lumbar Interbody Fusion.These patients were randomly divided into two groups:a control group consisting of 72 cases(33 males and 39 females)and an observation group consisting of 75 cases(37 males and 38 females).The control group underwent monitoring of motor evoked potentials(TceMEP)baseline after spinal exposure during the operation,while the observation group had immediate monitoring of TceMEP baseline after tracheal intubation without muscle relaxants.Hemodynamic changes,intubation satisfaction,and operation time during tracheal intubation were compared between the two patient groups.Additionally,the baseline success rate,stimulation threshold,sensitivity,and specificity of TceMEP were compared between the two groups.Results There were no significant differences in hemodynamic changes and intubation satisfaction between the two patient groups during tracheal intubation(P>0.05).The control group had an intubation time of(6.52±1.22)min,while the observation group had a significantly longer intubation time of(9.44±0.84)min(P<0.05).The baseline success rate of TceMEP in the observation group was 100%,with an average stimulation threshold of(225.00±22.13).In contrast,the control group had a baseline success rate of 84.72%and an average stimulation threshold of(342.01±31.07)V for TceMEP monitoring prior to nailing procedures.The success rate of monitoring TceMEP after nailing in the control group was 93.06%,whereas it reached 100%in the observation group,demonstrating a statistically significant difference between the two groups(P<0.05).There were no statistically significant differences in sensitiv⁃ity and specificity between the two groups for TceMEP monitoring re

关 键 词：运动诱发电位基线 术中神经电生理监测 无肌松药气管插管 腰椎手术 

分 类 号：B841.1[哲学宗教—基础心理学]