听觉诱发电位监测在脊柱侧弯术中唤醒试验的应用

Auditory Evoked Potential Index Monitoring for Waked-Up Test during Scoliosis Surgery

目的探讨听觉诱发电位（AEP）监测用于脊柱侧弯术中唤醒试验时预测唤醒时间的可行性。方法30倒ASAⅠ-Ⅱ级初次行后路矫正内固定手术的青少年脊柱侧弯患者，均采用全凭静脉麻醉。随机分为2组：Ⅰ组瑞芬太尼组（n＝15）和Ⅱ组芬太尼组（n＝15）。Ⅰ组麻醉用药为异丙酚＋阿曲库铵＋瑞芬太尼，Ⅱ组麻醉用药为异丙酚＋阿曲库铵＋芬太尼。唤醒试验完成后，立即加深麻醉。分别记录2．组唤醒时间，记录以下3个时点的听觉诱发电位指数（AAI）、平均动脉压（MAP）、心率（HR）的值：开始唤醒前即刻（T1）、患者对指令有反应时（佗）、唤醒试验完毕麻醉重新加深后（T3）。结果2组患者在唤醒时AAI值差异无统计学意义（P〉0．05），但唤醒时间差异有统计学意义（P〈0．05）。除Ⅱ组中有1例进行2次唤醒，其余患者均一次唤醒成功。任意时点的AAI值与MAP、HR无相关性。结论利用AEP监测能比较准确地预测脊柱侧弯术中唤醒试验时患者的苏醒。

Objective To investigate the possibility of predicting the time point when patients undergoing scoliosis surgery can be waked up by auditory-evoked potential（ AEP）index monitoring. Methods All thirty adolescents,ASA grade Ⅰ to Ⅱ,underwent total intravenous anesthesia （TIVA） in their posterior internal fixation operation. They were randomly divided into two groups： remifentanil anesthesia group （ group Ⅰ , n = 15） and fentanyl anesthesia group （ group Ⅱ . n = 15 ）. The anesthesia was induced and maintained with remifentanil,propofol and atracurium in group Ⅰ ,and with fentanyl, propofol and atracurium in group Ⅱ. Propofol 1 mg/kg was given intravenous as soon as the patients had movements to command. AAI, HR, Bp were continuously mo- nitored during operation and recorded at the three time points ： immediately before wake-up test （ TI ） , the patients were able to move according to command（T2） and anesthesia started again（ T3 ）. Results There was no marked difference ill AAI at the time point when tile patients were able to move according to command between the two groups. All patients could not recall the wake- up test. No correlation existed in AM;MAP ; HR. Conclusions AEP may be a useful clinical monitor to predict patient＇ s movement to command during intraoperative wakeup test.