新斯的明对脑瘫选择性后根切断术中神经肌肉电刺激反应的影响

Effect of Neostigmine on Cardiovascular Response from Neuromuscular Electrical Stimulation in Selective Posterior Rhizotomy for Patients with Cerebral Palsy

目的观察静脉预注射新斯的明对脑瘫选择性后根神经切断术中神经肌肉电刺激所致心血管反应的影响。方法在全麻下接受腰骶段选择性后根切断术的脑瘫患者56例,随机分成两组:新斯的明组(N组),在神经肌肉电刺激前5 min静脉注入新斯的明0.04 mg/kg,总量不超过1 mg,阿托品0.02 mg/kg,总量不超过0.5 mg;对照组(C组),在神经肌肉电刺激前5 min静脉注入生理盐水0.12 ml/kg。记录手术切皮前(T1)、注射试验药物或对照药物前(T2)、神经肌肉电刺激开始后1 min(T3)以及整个神经肌肉电刺激过程结束后10 min(T4)的心率和收缩压。结果N组在T3的收缩压和心率显著低于C组对应时间点(P<0.01);两组间在其他对应时间点上的HR和SBP没有显著性差异(P>0.05)。N组在神经肌肉电刺激过程中需要额外追加芬太尼的例数显著低于C组(P<0.01)。结论神经肌肉电刺激前静脉预注射新斯的明能够有效地降低神经肌肉电刺激所导致的心血管反应。

Objective To observe the effect of intravenous pre-injection of neostigmine on cardiovascular response （CVR） caused by neuromuscular electrical stimulation （NMES） in selective posterior rhizotomy （SPR） for patients with cerebral palsy. Methods 56 patients with cerebral palsy undergoing SPR at lumbarsacral segments under general anesthesia were randomly assigned to 2 groups： intravenous neostigmine 0.04 mg/kg （no more than 1 mg in total） and intravenous atropine 0. 02 mg/kg （no more than 0. 5 mg in total） 5 min before NMES in group N, and intravenous normal saline 0.12 ml/kg instead in group C. The systolic blood pressure （SBP） and heart rate （HR） at following time points： before skin incision （T1）, before intravenous neostigmine/atropine or normal saline injection （T2）, 1 min after NMES （T3）, and 10 min after NMES （T4）. Results SBP and HR at T3 in group N were significantly lower than those in group C （P〈0.01）. No significant difference was found at T1 , T2 and T4 between two groups （P〈0. 05）. Cases who needed extra dose of fentanyl during NMES in group N were significantly lower than those in group C （P〉0. 01）. Conclusion Intravenous pre-injection of neostigmine before NMES can effectively decrease the CVR caused by NMES.