丙泊酚靶控输注用于面神经监测下腮腺手术麻醉的研究

The Effects of Target Controlled Infusion of Propofol on Real-time Intraoperative Monitoring of Facial Nerve during Parotid Gland Surgery

目的观察评价丙泊酚靶控输注(TCI)对腮腺肿物切除及面神经探查手术中的面神经实时监测下面神经肌电活动收集的影响。方法 60例择期全麻下行腮腺肿物切除及面神经探查手术患者,气管插管后采用丙泊酚靶控输注麻醉,调整丙泊酚靶控输注血浆浓度为3μg/ml(A组)、4μg/ml(B组)、5μg/ml(C组)时,观察血压、心率及面神经肌电活动波形的振幅变化(振幅大于100mV监测有效),同时记录脑电双频谱指数(BIS)值的变化。结果神经监护仪所收集的面神经电活动振幅均大于350mV,全组患者的面神经实时监控均未中断;不同血浆浓度丙泊酚输注时,面神经肌电反应波形的振幅无明显差异性。A组血压、心率与术前比较无显著差异性(P>0.05),BIS值在40～45之间。B、C组血压、心率比术前明显降低,有显著差异性(P<0.01),BIS值在30～40之间。结论丙泊酚靶控输注全麻,既能维持腮腺肿物切除及面神经探查手术的血流动力学平稳,又不会影响面神经功能的监测,而且苏醒迅速,神经监测手术中可以推荐使用。

ObjectiveTo observe the effects of target controlled infusion of propofol infusion on real-time intraoperative monitoring of facial nerve during parotid gland surgery.Methods60 ASAⅠ or Ⅱpatients with parotid gland operation were performed target controlled infusion（TCI）of propofol infusion after intubation. BP, HR and real-time introoperative monitoring of facial nerve were recorded（the amplitude should be above 100mV） when the time of target serum concentration of propofol infusion were at 3μg/ml（group A）, 4μg/ml（group B）, 5μg/ml（group C）. And meanwhile BIS was monitored. ResultsThe amplitude of facial nerve had no chang during different target serum concentration of propofol infusion. The HR, BP decreased during 4 and 5μg/ml of propofol infusion and the BIS was within 30 to 40 at the same time. They had no change when propofol infusion at 3μg/ml and the BIS was within 40 to 45 during the operation. ConclusionTarget controlled infusion of propofol can be safely used in real-time intraoperative monitoring of facial nerve and has no inhibition effect on the action potential of facial nerve.It can decrease the cardiovescular reaction effectively and all the patients awake quickly. This method can be used in operation with nerve monitoring.