摘要
目的 比较七氟醚、异氟醚和地氟醚对神经外科手术患者经颅电刺激运动诱发电位(MEPs)的影响。方法择期行神经外科手术患者60例,年龄18~64岁,ASA分级Ⅰ或Ⅱ级。随机分为3组(n=20):七氟醚组、异氟醚组和地氟醚组。监测BIS值和经颅电刺激MEPs。调节七氟醚、异氟醚和地氟醚吸入浓度,使其呼气末浓度分别达到0.50、0.75、1.00和1.30MAC,每一浓度均维持15min,视为稳态呼气末浓度。于给予吸入麻醉药前(基础状态)和达到各稳态呼气末浓度(T1-4)时,记录MEPs的波幅和潜伏期以及BIS值。记录MEPs波形记录失败情况。结果与七氟醚组和异氟醚组比较,地氟醚组T1-2时波幅和BIS值降低,T1-4。时潜伏期延长(P〈0.05);七氟醚组和异氟醚组各指标比较差异无统计学意义(P〉0.05)。七氟醚组、异氟醚和地氟醚组基础状态、T1、T2时的记录失败率均为0;T1时记录失败率分别为0、5%和20%,三组比较差异无统计学意义(P〉0.05);T4时记录失败率分别为5%、20%和45%,与七氟醚组和异氟醚组比较,地氟醚组记录失败率升高(P〈0.05);七氟醚组和异氟醚组比较差异无统计学意义(P〉0.05)。结论地氟醚对神经外科手术患者经颅电刺激MEPs的抑制作用强于七氟醚和异氟醚。术中行MEPs监测时,七氟醚和异氟醚适宜的呼气末浓度为1.00MAC,地氟醚为0.75~1.00MAC。
Objective To compare the effects of sevoflurane, isoflurane and desflurane on transcranial electrical motor evoked potentials (MEPs) in patients undergoing neurosurgery. Methods Sixty ASA Ⅰ or Ⅱ patients aged 18-64 yr undergoing neurosurgery were randomly divided into 3 groups ( n = 20each) : sevoflurane group, isoflurane group and desflurane group. BIS value and MEPs were monitored. The end-tidal concentrations of sevoflurane, isoflurane and desflurane were adjusted and maintained at 0.50, 0.75, 1.00 and 1.30 MAC respectively for at least 15 min during 6 stimuli delivered at 1000 Hz and 300 V lasting for 75 μs. The amplitudes and latency of MEPs and BIS value were recorded before administration (baseline) and the each stable state (T1-4) . The failure rate of MEPs was also recorded. Results The amplitude of MEPs and BIS value were significandy decreased at T1,2 and the latency of MEPs was prolonged at T1-4 in desflurane group compared with sevoflu- rane and isoflurane groups ( P 〈 0.05) . There was no significant difference in the amplitudes and latency of MEPs and BIS value between group sevoflurane and isoflurane ( P 〉 0.05). The failure rates of MEPs were 0 at baseline, Tt and T2, 0, 5% and 20% at T3 , and 5% , 20% and 45% at T4 in sevoflurane, isoflurane and desflurane groups respectively. The failure rate of MEPs was significantly higher in desflurane group than in sevoflurane and isoflurane groups ( P 〈 0.05 ). Conclusion Desflurane has greater suppressive effect on MEPs than sevoflurane and isoflurane. 1.00 MAC of sevoflurane and isoflurane, while 0.75-1.00 MAC of desflurane may be the suitable end-tidal concentration for MEP monitoring.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2010年第12期1409-1411,共3页
Chinese Journal of Anesthesiology
关键词
麻醉药
吸入
异氟醚
诱发电位
运动
电刺激
Anesthetics, inhalation
Isoflurane
Evoked potentials, motor
Electric stimulation