三种全麻方式对脑干三叉神经诱发电位的影响

Effects of three methods of general anesthesia on the brain stem trigeminal evoked potential

目的观察三种全身麻醉方式对脑干三叉神经诱发电位（BTEP）的影响。方法180例择期三叉神经微血管减压术患者，ASAI或Ⅱ级，随机均分为三组：七氟醚吸入麻醉组（A组），丙泊酚复合雷米芬太尼全凭静脉麻醉组（B组）和静一吸复合麻醉组（c组）三组。术中BIS维持在35～45。监测术前（T1）、麻醉后1h（R）和微血管减压后（瓦）BTEP的Wz、w3潜伏期及W3-W1的波阉期（IPLD）。结果三组患者T1和T2分别有48例（A组）、53例（B组）、52例（C组）测得BTEP波形及W1、W3潜伏期和IPLD，其余患者BTEP波形不明显，潜伏期未测得。T3时三组患者均可测得BTEP波形及W1、W3潜伏期和IPLD，且明显短于T1、T2时（P〈0．05）。T1、T2时未测得BTEP波形的患者L时可见BTEP融合波，W1潜伏期仍未测得。结论三叉神经痛患者微血管减压术中采用三种不同全麻方式对BTEP的监测无显著影响，BTEP可以有效地监测微血管减压效果。

Objective To observe the effects of three methods of general anesthesia on the brain stem trigeminal evoked potential （BTEP）. Methods One hundred and eighty patients undergoing elective trigeminal nerve microvascular decompression, ASA Ⅰ or Ⅱ , were randomly divided into three groups., inhalation sevoflurane （ group A）, total intravenous anesthesia （ group B） and intravenous anesthesia combined with inhalation anesthesia （group C）. BIS values of the three groups were maintained at 35-45. Latentperiod of W1, W3 in BTEP and W3-W1 Interpeak latency differences （IPLD） were recorded at the time of preoperation （T1）, one hour after anesthesia induction （T2） and after mierovaseular decompression （T3）. Results In the T1 and T2 of three groups, there were 48 cases （group A）, 53 eases （group B）, 52 cases （group C） whose BTEP waveforms and W1, W3 latency and IPLD can be measured. In the other patients, BTEP waveforms, W1, W3 latency and IPLD can not be measured. There were significant decrease of W1 , W3 latency and IPLD values （P〈0. 05） at T3. In patients who originally could not be measured the BTEP waveforms in T1 and T2, in T3 can he measured the waves of BTEP. Conclusion Three methods of general anesthesia have no significant difference effect on the BTEP monitoring in patients with trigeminal nerve mierovascular decompression, and BTEP can effectively monitor the effect of microvascular decompression.