听觉诱发电位监测在脊柱手术患者术中唤醒的应用

Application of AEP monitoring during intraoperative wake-up test of spinal surgery

目的观察雷米芬太尼-丙泊酚-阿曲库铵全凭静脉麻醉下听觉诱发电位(AEP)监测在脊柱手术患者术中唤醒试验中的作用。方法20例择期行脊柱矫形内固定手术患者采用雷米芬太尼-丙泊酚-阿曲库铵全凭静脉麻醉,术中应用AEP监测麻醉深度,双盲法记录开始唤醒试验即刻(T1)、患者按照指令反应时(T2)和唤醒试验完毕加深麻醉后(T3)的听觉诱发电位指数(AAI),以及唤醒试验期间AAI最大值,术后第1天随访患者对唤醒试验及术中其他事件的回忆情况。结果T1、T2和T3时的AAI分别为23±5、78±10、21±4(P<0.05),唤醒试验期间T2时AAI最高,AAI最大值与患者按照指令反应时间上同步。6例患者对术中唤醒经过有记忆,但对术中其他事件无回忆。该6例患者唤醒期间AAI最大值与其他患者比较差异无统计学意义。结论脊柱手术术中唤醒试验中应用AEP监测,能够有效预测患者能否按照指令反应,对唤醒试验起重要指导作用。

Objective To evaluate the auditory-evoked potential （AEP） monitoring and explicit memory during intraoperative wake-up test of spinal surgery with propofol-remifentanil anesthesia. Methods Twenty ASA class Ⅰ or Ⅱ patients were received propofol-remifentanil anesthesia and wake-up test during corrective surgery of the spine. AEP was used to monitor the depth of anesthesia. AAI was blinded to record in the four time periods of before starting the wake-up test （T1）, patient movement to command（T2）, after the patient was reanesthetized（T3） and the maximal AAI during wake-up test. The next day after operation, the patients were interviewed and asked whether they could recall intraoperative events including pain, voice or the given color during the wake-up test. Results All patients were performed wake-up test successfully. The wake-up time （T2-T1） was（5.4 ± 1.9） rain. AAI was significantly higher in T2 than that in T1 （P〈0.05）, and significantly declined after reanesthetized （T3） （P〈0.05）. There was no a latent period between the maximal AAI and patients＇ awakening. During the postoperative follow-up,six patients recalled the wake-up test and one of them recalled the specified color. No patient recalled intraoperative pain and other events. Compared with other patients without recalling, the maximal AAI of these six patients was not statistically different. Conclusion AEP monitoring is useful in patients undergoing spinal surgery with propofol remifentanil anesthesia,which can predict patient movement to command.