不同肌松水平对术中脊髓神经电生理监测的影响

发布时间：2018-04-12 17:27

本文选题：脊髓功能监测 + 神经肌肉阻滞　；参考：《首都医科大学学报》2017年03期

【摘要】：目的比较不同肌松水平[4个成串刺激(train of four stimulation,TOF)的T1分别为5%~15%基础值和45%~55%基础值水平]对脊柱手术中脊髓神经电生理监测结果的影响,探讨安全有效的电生理监测麻醉方案。方法选择行术中脊髓神经电生理监测的择期脊柱手术病人23例。采用丙泊酚和瑞芬太尼全凭静脉麻醉,阿曲库铵维持肌松,监测拇内收肌TOF指示肌松水平,监测体感诱发电位(somatosensory evoked potentials,SEP)和运动诱发电位(motor evoked potentials,MEP)评判脊髓功能。分别记录神经肌肉阻滞水平1(neuromuscular blockade level 1,NMB_1)(T1为5%~15%基础值)和NMB_2水平(T1为45%~55%基础值)时SEP和MEP的波幅和潜伏期,同时记录经颅电刺激时病人是否出现剧烈体动和自主呼吸。结果不同肌松水平的SEP波幅和潜伏期之间差异均无统计学意义(P0.05)。同一监测部位不同肌松水平的MEP潜伏期差异无统计学意义(P0.05),左上肢和右下肢不同肌松水平的MEP波幅则差异有统计学意义(P0.05)。NMB2水平时的经颅电刺激时剧烈体动发生率明显高于NMB1水平时(P0.05)。两个肌松水平经颅电刺激时均无自主呼吸产生。结论肌松剂的使用在行神经电生理监测的脊柱手术中并非完全禁忌,TOF的T1在45%~55%基础值的肌松水平可能是高风险脊髓手术较理想的肌松水平。
[Abstract]:Methods 23 patients undergoing spinal surgery were selected for intraoperative spinal cord electrophysiological monitoring.The amplitudes and latencies of SEP and MEP were recorded at 1(neuromuscular blockade level 1nmb 1T 1 (5 / 15% base value) and NMB_2 (T 1 = 45 55%), respectively. At the same time, the intensity of body movement and spontaneous respiration during transcranial electrical stimulation were recorded.Results there was no significant difference in SEP amplitude and latency between different muscle relaxation levels (P 0.05).There was no significant difference in the latency of MEP between different muscle relaxation levels at the same monitoring site. The amplitude of MEP wave at different levels of muscle relaxation in left upper limb and right lower extremity was significantly different. There was a significant difference in the incidence of severe somatokinetic activity during transcranial electrical stimulation at different levels of P0.05. NMB2.When the level of NMB1 was significantly higher than that of P0. 05.There was no spontaneous respiration during transcranial electrical stimulation at both levels of muscle relaxation.Conclusion the use of muscle relaxant in spinal surgery with neurophysiological monitoring is not completely contraindicated. The T 1 of TOF is at the level of 45% and 55%, which may be the ideal level of muscle relaxation in high-risk spinal cord surgery.
【作者单位】：北京大学第三医院麻醉科;北京大学第三医院神经电生理监测室;
【分类号】：R614

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