脊柱侧弯矫形术中不同麻醉方法对神经电生理监测指标SEP及MEP的影响

发布时间：2018-05-15 05:32

本文选题：脊柱侧弯矫形术 + 体感诱发电位　；参考：《山东大学》2014年硕士论文

【摘要】：研究背景：随着脊柱外科的发展,高难度的手术越来越多,术中神经电生理监测应用也越来越广泛,体感诱发电位和运动诱发电位因操作简单、准确性高成为脊柱矫形术中脊髓神经功能监测最常用的方法,但围术期不同麻醉药或麻醉方法对其准确性有一定影响。研究目的：探讨10-15岁的青少年患者脊柱侧弯矫正术中七氟醚-丙泊酚静吸复合麻醉和丙泊酚全凭静脉麻醉对体感诱发电位和运动诱发电位的影响并对两种麻醉方法的效果进行评估。研究对象： 60例术中需要行脊髓功能监测的青少年脊柱侧弯患者。研究方法：选择择期行脊柱侧弯矫形术的青少年患者60例,年龄10-15岁,ASA ⅠⅡ级,应用随机分组法分成两组：A组(丙泊酚全凭静脉麻醉组)和B组(七氟醚-丙泊酚静吸复合麻醉组)。两组均采用静脉快诱导麻醉,插管成功后A组以丙泊酚维持麻醉,B组吸入低于1MAC的七氟醚复合丙泊酚维持麻醉,两组患者术中均使用舒芬太尼镇痛,术中均根据脑电双频指数(BIS维持在45-55)调整丙泊酚输入剂量,同时监测诱发电位。术中记录诱发电位波幅和潜伏期的变化及血流动力学波动,术后观察患者苏醒质量并记录患者对麻醉手术过程是否有记忆。研究结果： 1、两组患者术前一般情况(年龄、体重、性别、手术时间、术中出血量等)差异无统计学意义(P0.05)； 2、两组患者术中血流动力学均平稳,丙泊酚组平均动脉压高于七氟醚-丙泊酚组,而心率则低于七氟醚-丙泊酚组但是差异均无统计学意义(P0.05)。 3、与丙泊酚组相比,七氟醚-丙泊酚组诱发电位的波幅降低(P0.05)差异有统计学意义,而两组患者诱发电位的潜伏期差异无统计学意义(P0.05)；两组患者术中均可记录到清晰可重复的诱发电位波形；两组患者术后均没有神经瘫痪症状,对手术过程均无记忆。 4、术后七氟醚-丙泊酚组患者术后睁眼时间(10.5±6.8min)短于丙泊酚组(19.8±9.8min),拔管时间(15.9±10.5min)短于丙泊酚组(25.4±13.3min)差异有统计学意义(P0.05), 结论：低于1MAC的七氟醚复合丙泊酚静吸复合麻醉和丙泊酚全凭静脉麻醉均可安全用于须行SEP和MEP监测的脊柱侧弯矫形术中,对诱发电位无显著影响,而且术中血流动力学稳定,无术中知晓发生,是较理想的麻醉方法,尤其是七氟醚-丙泊酚静吸复合麻醉患者苏醒快,更利于术后神经功能的评估。
[Abstract]:Background: With the development of spinal surgery, more and more difficult surgery, intraoperative nerve electrophysiological monitoring is also more and more widely used, somatosensory evoked potential and motor evoked potential because of simple operation. High accuracy is the most commonly used method for spinal cord nerve function monitoring in spinal orthopedic surgery, but different anesthetic or anesthetic methods in perioperative period have some influence on the accuracy of spinal cord nerve function monitoring. Objectives of the study: To investigate the effects of sevoflurane propofol combined anesthesia and propofol total intravenous anesthesia on somatosensory evoked potential and motor evoked potential during scoliosis correction in adolescents aged 10-15 years. Subjects: 60 adolescent scoliosis patients who needed spinal cord function monitoring during operation. Research methods: Sixty adolescent patients aged 10-15 years who underwent scoliosis correction were randomly divided into two groups: group A (propofol total intravenous anesthesia group) and group B (sevoflurane / propofol intravenous combined anesthesia group). Group A received propofol maintenance anesthesia group B inhaled less than 1MAC sevoflurane combined with propofol maintenance anesthesia. Sufentanil was used for analgesia in both groups. During the operation, the dose of propofol was adjusted according to the bispectral index (BIS) and the evoked potential was monitored. The amplitude and latency of evoked potential and hemodynamic fluctuation were recorded during the operation. The postoperative recovery quality was observed and the memory of the patients during anesthesia operation was recorded. Results of the study: 1. There was no significant difference between the two groups (age, weight, sex, operative time, intraoperative bleeding, etc.). The mean arterial pressure of propofol group was higher than that of sevoflurane-propofol group, but the heart rate was lower than that of sevoflurane-propofol group, but there was no significant difference between them. 3Compared with propofol group, the amplitude of evoked potential in sevoflurane and propofol group was significantly lower than that in propofol group (P 0.05). However, there was no significant difference in latency of evoked potential between the two groups (P 0.05). All the patients in the two groups recorded clear and repeatable evoked potential waveforms during operation. There were no symptoms of paralysis and no memory of the operation process in both groups. (4) the postoperative time of eye opening in sevoflurane propofol group was 10.5 卤6.8 minutes, which was significantly shorter than that in propofol group (19.8 卤9.8 min, 15.9 卤10.5 min) and propofol group (25.4 卤13.3 min). Conclusion: Sevoflurane combined with propofol combined anesthesia and total propofol intravenous anesthesia lower than 1MAC can be safely used in scoliosis orthopedics requiring SEP and MEP monitoring. There was no significant effect on evoked potential and hemodynamics was stable during operation. It is an ideal anaesthesia method, especially sevoflurane-propofol combined anesthesia, to wake up quickly and to evaluate the neurological function after operation.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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