腓肠肌肌腱痛刺法在小儿脊柱侧弯术中脊髓功能判断的临床观察

Clinical observation on itraoperative wake-up test by gastrocnemius muscle tendon stimulation in children undergoing scoliosis surgery

目的 探讨腓肠肌肌腱痛刺法在脊柱侧弯患者术中进行脊髓功能判断的可行性.方法 将20例行脊柱侧弯手术的患儿随机分为腓肠肌肌腱痛刺组和术中唤醒组.麻醉诱导：丙泊酚2 mg/kg、瑞芬太尼1μg/kg、顺式阿曲库铵0.1 mg/kg;麻醉维持：丙泊酚2mg/kg/h、瑞芬太尼0.25μg/kg/min和3%～4%异氟醚.分别观察术中腓肠肌肌腱痛刺法和术中唤醒法与术后患儿清醒后脊髓功能变化,并记录苏醒时间与血流动力学变化.结果 所有患儿术后脊髓功能均正常.唤醒组的MAP、HR在麻醉前和唤醒时分别为（62.6±3.4）mmHg、（76.6±7.3）bpm和（92.6±7.6）mmHg、（132.6±13.4）bpm,差异有显著性（P＜0.05）.腓肠肌刺痛法组的MAP、HR在麻醉前和唤醒时分别为（63.3±3.2）mmHg、（68.7±5.4）bpm以及（95.6±6.3）mmHg、（112.6±9.5）bpm,差异无显著性（P＞0.05）.腓肠肌刺痛法组所用的时间（842±65）s与唤醒组（465±71）s相比,差异有显著性（P＜0.05）.结论 在小儿脊柱侧弯手术中采用腓肠肌肌腱痛刺法对术中脊髓功能判断是有效和可行的,尤其适用于不合作的患儿.

Objective To observe the gastrocnemius muscle tendon stimulation effect for diagnosis spinal function in scoliosis surgery for children. Methods 20 scoliosis patients were randomly divided into gastrocnemius muscle tendon stimulation group and traditional wake-up test group. All patients were induced with propofol,remifentynil, cisatracurium and maintained with propofol, remifentynil and isofrane. Spinal function changes were observed postoperatively in two groups. Results After the operation, all patients＇ spinal function was normal. The MAP, HR of wake-up group were （62.6±3.4） mmHg, （92.6±7.6） bpm respectively before anaesthesia, and were （76.6±7.3） mmHg, （132.6±13.4） bpm respectively at the wake-up time （P〈0.05）. The MAP, HR of gastrocnemius muscle tendon stimulation group were （63.3±3.2） mmHg, （95.6±6.3） bpm respectively before anaesthesia, and were （68.7±5.4） mmHg, （112.6±9.5） bpm respectively at the wake-up time（P〉0.05）. The patients of wake-up group needed （842±65） s to come round, while the ones of gastrocnemius muscle tendon stimulation group need （465±71）s. Conclusion Gastrocnemius muscle tendon stimulation may be an effective method to evaluate the spinal function during scoliosis surgery in children.