不同剂量右美托咪定对SEP联合MEP监测神经外科手术患者的影响

发布时间：2018-05-02 01:08

本文选题：右美托咪定 + 体感诱发电位　；参考：《实用医学杂志》2017年10期

【摘要】：目的:探讨不同剂量右美托咪定对体感诱发电位(SEP)联合运动诱发电位(MEP)监测神经外科手术患者的影响。方法:择期需做SEP联合MEP监测脑肿瘤切除术患者80例,随机分为四组:C组、D_1组、D_2组和D_3组。麻醉诱导前D_1组、D_2组和D_3组经静脉10 min输注右美托咪定0.5μg/kg,后以右美托咪定0.1、0.3μg/(kg·h)和0.5μg/(kg·h)维持至术毕,C组采取同样方法予以等容量生理盐水。于入室时(T_1),切皮时(T_2),停肌松药时(T_3),停肌松药后50 min(T4)观察MAP、HR和BIS值;记录初次诱发MEP的电流强度和监测等待时间,T4时SEP(N20-P25,N20)及大鱼际肌MEP波幅和潜伏期;同时记录术中丙泊酚用量和不良反应发生情况。结果:T_2~T_4时D_2组和D_3组HR明显慢于、MAP明显低于C组和D_1组(P0.05)。D_2组和D3组丙泊酚用量明显低于C组和D_1组;D_2组诱发MEP的电流强度明显低于C组、D_1组和D_3组,D_3组明显低于C组;T_4时D_2组MEP波幅明显高于C组、D_1组和D_3组,D_3组明显高于C组(P0.05)。四组患者其余指标差异无统计学意义(P0.05)。结论:麻醉诱导前静脉输注右美托咪定0.5μg/kg后以右美托咪定0.3μg/(kg·h)维持,能够降低丙泊酚用量间接改善MEP监测质量,对MEP抑制作用更小,对SEP无明显影响,且血流动力学稳定。
[Abstract]:Aim: to investigate the effects of dexmetidine on somatosensory evoked potentials (SEP) combined with motor evoked potentials (MEP) in patients undergoing neurosurgery. Methods: a total of 80 patients undergoing brain tumor resection were randomly divided into four groups: group 1: group D _ (1) and group D _ (1) and group D _ (2) and group D _ (3). Before anesthesia induction, group D _ 1 and group D _ 3 received intravenous infusion of dexmetomidine 0.5 渭 g / kg for 10 min, then dexmetomidine (0.1 渭 g/(kg 路h) and 0.5 渭 g/(kg (h) until the end of operation. Group C received the same volume of saline. At the time of entry, T _ 1, T _ 2, T _ 3, T _ 3 and T _ 4) were observed. The current intensity of MEP was recorded and the amplitude and latency of SEPN20-P25N20 at T _ 4) and the amplitude and latency of MEP in thenar muscles were recorded. The dosage of propofol and the incidence of adverse reactions were also recorded. Results the HR of group D2 and DSP 3 was significantly slower than that of group C and group D1 at the time of life. Results the dosage of propofol in group 2 and D3 was significantly lower than that in group C and group D1, and the current intensity of MEP induced in group D2 was significantly lower than that in group C and group D3. In group C, the amplitude of MEP in group D _ 2 was significantly higher than that in group D _ 1 and D _ T _ 3 in group C, and in group D _ 3, it was significantly higher than that in group C (P 0.05). There was no significant difference in other indexes among the four groups (P 0.05). Conclusion: before anesthesia induction, intravenous infusion of dexmetomidine (0.5 渭 g/kg) and dexmetomidine (0.3 渭 g/(kg / h) can indirectly improve the quality of MEP monitoring by reducing the dosage of propofol, and the inhibition of MEP is less, but the effect on SEP is not obvious, and the hemodynamics is stable.
【作者单位】：宁波市第二医院麻醉科;南昌大学第一附属医院麻醉科;南昌大学第一附属医院神经外科;
【基金】：江西省教育厅科学技术研究项目(编号:GJJ12080)
【分类号】：R614;R739.41

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