吸入麻醉药七氟醚和异氟醚对上肢运动诱发电位的影响
发布时间：2018-11-27 09:33
【摘要】：研究目的:以上肢运动诱发电位(MEP)的潜伏期和波幅变化为指标，采用序贯法定量测定吸入麻醉药七氟醚和异氟醚使上肢运动诱发电位(MEP)成功监测的ED50值，及其95%的可信区间。 方法:随机选择ASAI～II级，拟行全麻下行择期颅脑手术患者37例，年龄45~65岁，随机分为两组：七氟醚组（I组：n=18）；异氟醚组（II组：n=19）。两组在麻醉诱导前均静脉注射咪达唑仑0.05mg/kg。 I组患者按序贯法吸入七氟醚，初始浓度设为2.8％，系列浓度为2.8％、2.4％、2.0％，间隔为0.4%。每种预设呼气末浓度各维持15min，观察患者上肢拇短展肌的运动诱发电位的波形。若患者15min内波形消失，将监测结果，定为阳性（＋），，则下一例患者所用七氟醚的浓度，就降低一个浓度间隔;反之，若病人15min内波形未消失，将监测结果，定为阴性（－），则下一例患者所用七氟醚的浓度就增加一个浓度间隔。当出现6个由（＋）至（－）的交叉点(cross·over)时，终止本组实验。 II组患者按序贯法吸入异氟醚，诱导方式相同，但初始浓度设为2.0％，系列浓度为2.0％、1.6％、1.2％，间隔亦为0.4%。同样观察运动诱发电位的波形，当出现6个由（＋）至（－）的交叉点(cross·over)时，终止本组实验。每隔5min，记录病人平均动脉压（MAP）、心率（HR）及脉搏氧饱和度（SpO2）和呼气末二氧化碳分压（ETCO2），分别计算七氟醚和异氟醚使上肢MEP监测成功的ED50，及其95％的可信区间。 结果:（1）I组七氟醚的ED50为2.35%（1.39MAC），其95％的可信区间为2.21％~2.50 ％（1.31MAC~1.47MAC）； （2）II组异氟醚的ED50为1.59％（1.38MAC），其95％的可信区间为1.50％~1.67％（1.30MAC-1.45MAC）。 （3）当七氟醚呼气末浓度为2.0%时，上肢运动诱发电位（MEP）监测成功率为100%；呼气末浓度为2.4%时，上肢运动诱发电位（MEP）监测成功率为33%；呼气末浓度为2.8%时，上肢运动诱发电位（MEP）监测成功率为0。 （4）当异氟醚呼气末浓度为1.2%时，上肢运动诱发电位（MEP）监测成功率为100%；呼气末浓度为1.6%时，上肢运动诱发电位（MEP）监测成功率为44%；呼气末浓度为2.0%时，上肢运动诱发电位（MEP）监测成功率为0。 结论: 实行上肢运动诱发电位（MEP）监测时， （1）单独应用七氟醚麻醉时，使上肢运动诱发电位监测成功的ED50是2.35％（1.39MAC），其95％的可信区间为2.21％-2.50％（1.31MAC-1.47MAC）； （2）单独应用异氟醚麻醉时，使上肢运动诱发电位监测成功ED501.59％（1.38MAC），其95％的可信区间为1.50％-1.67％（1.30MAC-1.45MAC）； （3）七氟醚能抑制上肢运动诱发电位（MEP）的产生，对诱发电位的影响呈剂量依赖性； （4）异氟醚能抑制上肢运动诱发电位（MEP）的产生，对诱发电位的影响呈剂量依赖性。
[Abstract]:Objective: to determine the ED50 values of the upper limb motor evoked potential (MEP) successfully monitored by sevoflurane and isoflurane by sequential quantitative method with the change of latency and amplitude of upper limb motor evoked potential (MEP). And its 95% confidence interval. Methods: 37 patients, aged 45 to 65, were randomly divided into two groups: sevoflurane group (group I: n = 18) and isoflurane group (group II: n = 19). Before anesthesia induction, midazolam was injected intravenously with 0.05 mg / kg midazolam in both groups. In group I, sevoflurane was inhaled sequentially, the initial concentration was 2.8, and the serial concentration was 2.82.42.0.The interval was 0.4. Each preset end-expiratory concentration was maintained for 15 min, and the waveform of motor evoked potential of abductor pollicis brevis muscle was observed. If the waveform disappeared in the patient's 15min and the monitoring result was positive (+), the concentration of sevoflurane used in the next patient was reduced by one concentration interval. On the other hand, if the waveform in the patient's 15min does not disappear, the monitoring results are negative (-), then the concentration of sevoflurane used in the next patient increases by a concentration interval. When there were 6 cross points (+) to (-) (cross over), the experiment was terminated. In the II group, isoflurane was inhaled in the same way, but the initial concentration was 2.0 and the serial concentration was 2.01.2.The interval was 0.450. The waveform of motor evoked potential was also observed. When there were 6 crossing points (+) to (-), the experiment was terminated. The mean arterial pressure (MAP), pulse oxygen saturation (SpO2) and end expiratory carbon dioxide partial pressure (ETCO2) were recorded every 5 min. The ED50, of sevoflurane and isoflurane for MEP monitoring of upper extremity were calculated, respectively. And its 95% confidence interval. Results: (1) in group I, the ED50 of sevoflurane was 2.35% (1.39MAC), and its 95% confidence interval was 2.21% (1.31MAC~1.47MAC). (2) the ED50 of isoflurane in II group was 1.59% (1.38MAC), and its 95% confidence interval was 1.50% 1.67% (1.30MAC-1.45MAC). (3) when the end-expiratory concentration of sevoflurane was 2.0, the success rate of (MEP) monitoring of upper limb motor evoked potential was 100, and the success rate of (MEP) monitoring of upper limb motor evoked potential was 33 when the end expiratory concentration was 2.4. When the end expiratory concentration was 2.8, the success rate of (MEP) monitoring of upper limb motor evoked potential was 0. 0. (4) when the end-expiratory concentration of isoflurane was 1.2, the success rate of (MEP) monitoring of upper limb motor evoked potential was 100, and the success rate of (MEP) monitoring of upper limb motor evoked potential was 44 when the end expiratory concentration was 1.6. The success rate of (MEP) monitoring of motor evoked potential in upper extremity was 0. 0 when the end expiratory concentration was 2. 0. Conclusion: when the upper limb motor evoked potential (MEP) was monitored by (MEP), (1) when sevoflurane was used alone, the ED50 of the upper limb motor evoked potential monitoring was 2.35% (1.39MAC). The 95% confidence interval was 2.21- 2.50% (1.31MAC-1.47MAC). (2) when isoflurane was used alone, the upper limb motor evoked potential (1.38MAC) was monitored successfully with 95% confidence interval of 1.50- 1.67% (1.30MAC-1.45MAC); (3) sevoflurane could inhibit the production of (MEP) in upper limb motor evoked potential in a dose-dependent manner. (4) Isoflurane could inhibit the production of (MEP) in upper limb motor evoked potential in a dose-dependent manner.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614.4
[Abstract]:Objective: to determine the ED50 values of the upper limb motor evoked potential (MEP) successfully monitored by sevoflurane and isoflurane by sequential quantitative method with the change of latency and amplitude of upper limb motor evoked potential (MEP). And its 95% confidence interval. Methods: 37 patients, aged 45 to 65, were randomly divided into two groups: sevoflurane group (group I: n = 18) and isoflurane group (group II: n = 19). Before anesthesia induction, midazolam was injected intravenously with 0.05 mg / kg midazolam in both groups. In group I, sevoflurane was inhaled sequentially, the initial concentration was 2.8, and the serial concentration was 2.82.42.0.The interval was 0.4. Each preset end-expiratory concentration was maintained for 15 min, and the waveform of motor evoked potential of abductor pollicis brevis muscle was observed. If the waveform disappeared in the patient's 15min and the monitoring result was positive (+), the concentration of sevoflurane used in the next patient was reduced by one concentration interval. On the other hand, if the waveform in the patient's 15min does not disappear, the monitoring results are negative (-), then the concentration of sevoflurane used in the next patient increases by a concentration interval. When there were 6 cross points (+) to (-) (cross over), the experiment was terminated. In the II group, isoflurane was inhaled in the same way, but the initial concentration was 2.0 and the serial concentration was 2.01.2.The interval was 0.450. The waveform of motor evoked potential was also observed. When there were 6 crossing points (+) to (-), the experiment was terminated. The mean arterial pressure (MAP), pulse oxygen saturation (SpO2) and end expiratory carbon dioxide partial pressure (ETCO2) were recorded every 5 min. The ED50, of sevoflurane and isoflurane for MEP monitoring of upper extremity were calculated, respectively. And its 95% confidence interval. Results: (1) in group I, the ED50 of sevoflurane was 2.35% (1.39MAC), and its 95% confidence interval was 2.21% (1.31MAC~1.47MAC). (2) the ED50 of isoflurane in II group was 1.59% (1.38MAC), and its 95% confidence interval was 1.50% 1.67% (1.30MAC-1.45MAC). (3) when the end-expiratory concentration of sevoflurane was 2.0, the success rate of (MEP) monitoring of upper limb motor evoked potential was 100, and the success rate of (MEP) monitoring of upper limb motor evoked potential was 33 when the end expiratory concentration was 2.4. When the end expiratory concentration was 2.8, the success rate of (MEP) monitoring of upper limb motor evoked potential was 0. 0. (4) when the end-expiratory concentration of isoflurane was 1.2, the success rate of (MEP) monitoring of upper limb motor evoked potential was 100, and the success rate of (MEP) monitoring of upper limb motor evoked potential was 44 when the end expiratory concentration was 1.6. The success rate of (MEP) monitoring of motor evoked potential in upper extremity was 0. 0 when the end expiratory concentration was 2. 0. Conclusion: when the upper limb motor evoked potential (MEP) was monitored by (MEP), (1) when sevoflurane was used alone, the ED50 of the upper limb motor evoked potential monitoring was 2.35% (1.39MAC). The 95% confidence interval was 2.21- 2.50% (1.31MAC-1.47MAC). (2) when isoflurane was used alone, the upper limb motor evoked potential (1.38MAC) was monitored successfully with 95% confidence interval of 1.50- 1.67% (1.30MAC-1.45MAC); (3) sevoflurane could inhibit the production of (MEP) in upper limb motor evoked potential in a dose-dependent manner. (4) Isoflurane could inhibit the production of (MEP) in upper limb motor evoked potential in a dose-dependent manner.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614.4
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