脊柱侧弯矫正术应用维库溴铵对神经电生理监测的影响

Effects of vecuronium on monitoring nerve-electrophysiology during scoliosis surgery

目的:探讨脊柱侧凸矫正手术麻醉过程中,非去极化肌松药维库溴胺剂量对神经电生理监测造成的影响。方法:37例行脊柱侧凸矫正手术的病人,入室后行SEP、MEP和EMG等监测,全麻诱导后持续泵注异丙酚(4～8 mg·kg^(-1)·h^(-1))和芬太尼(4～5μg·kg^(-1)·min^(-1)),根据调节维库溴胺浓度方法的不同,将病人分为2组:Ⅰ组:维库溴胺0.05 mg·kg^(-1)·h^(-1)(ED_(95)·kg^(-1)·h^(-1)),Ⅱ组:维库溴胺0.1 mg·kg^(-1)·h^(-1)(2ED_(95)·kg^(-1)·h^(-1))。2组均于诱导后5 min开始给药,连接电生理监测电极和肌松监测电极。Ⅰ组和Ⅱ组分别在脊柱暴露前后,监测神经电生理变化,监测神经诱发电位和肌电图波形及潜伏期数值,记录2组神经传导波幅和传导速度。整个麻醉期间监测血氧饱和度、血压、心率、中心静脉压和呼吸末二氧化碳分压。结果:(1)Ⅰ组与Ⅱ组相比患者的收缩压下降11.37%,舒张压下降12.75%,平均动脉压>60 mmHg,2组患者脉搏氧饱和度均>96%,差异无统计学意义。(2)Ⅰ组和Ⅱ组患者SEP传导速度差异无统计学意义(P>0.05)。Ⅰ组患者MEP和EMG潜伏期和传导速度能逐渐引出.Ⅱ组没有引出MEP,EMG,2组有明显差异。结论:2组SEP神经传导速度和潜伏期没有明显变化,对SEP没有影响,而手术中应用非去极化肌松药维库溴胺的剂量对术中神经电生理监测MEP和EMG有影响。

Objective： During the process of investigating anesthesia for sco impact of non-depolarizing muscular relaxant vecuronium to electrophysio iosis surgery, to speculate the ogy according to the fact that with the application of non-depolarizing muscular relaxant vecuronium, muscle relaxation take effect grad- ually in the process and gradual return of waveform monitoring changes. Method： Thirty-seven ASA Class I or 1% in patients undergoing scoliosis surgery under vecuronium anesthesia were divided into two groups, vecuronium ED95· kg-1· h -1 and vecuronium 2 ED95· kg-1· h -1. After induction of general an- esthesia propofol was infused at the rate of （4-8） mg·kg-1·h-1 and fentany 4-5 μg· kg-1 · min-1. Then ECG, HR, DBP, SBP, MAP, SpOt, PETCO2 were monitered. At the beginning of anesthesia in five minuties, link the electrodes of monitoring muscle relaxation and monitoring electrodes, make the con- trol the electrodes of monitoring muscle relaxation and monitoring electrodes during operation. After in- ducement of anesthesia, starting the monitoring of SEP. MEP and EMG waveform in the two groups he- fore and after scoliosis was opened. Two nerve conduction velocity, and latency values were recorded. Re- sult： （1） Changes of the blood pressure： compare the systolic and diastolic blood pressure, systolic blood pressure decreased 11. 37% , 12. 75% decline in diastolic blood pressure, mean arterial pressure in two groups were more than 60 mmHg, SpO2 in two groups were more than 96%, there was no statistically sig- nificant difference between the two groups. （2） There was no statistically significant difference between the two groups in SEP conduction velocity （P〉0.05）. （3） There were satistically significant differences between the two groups in MEP, EMG conduction velocity. Conclusions： This study showed that MEP and EMG did change significantly by the application of vecuronium when the rate of vecuronium infusion was ED95· kg-1· h -1. At the same time, through the speculation of the nerve conduction velocity and the latency. So non-depolarizing muscular relaxant vecuronium may has no impact on monitoring SEP nerve electrophysiology. So vecuronium （ED95· kg-1· h -1） anesthesia in the scoliosis surgery can monitoring SEP, MEP and EMG and satisfying with need of operating and monitoring.