两种静脉麻醉技术在需行脊髓功能监测的脊柱矫形手术中的应用

Comparative study on two total intravenous anesthesia techniques in complex spine surgery

目的:对靶控输注和人工调控输注两种静脉麻醉技术在脊柱畸形矫正手术中的应用进行前瞻对比研究。方法:选择择期行脊柱后凸矫正和脊柱侧弯矫正的患者160例,按照随机数字表随机分为靶控输注组(target-con-trolled infusion,TCI)和人工调控输注组(manual-controlled infusion,MCI),TCI组麻醉全程采用丙泊酚和瑞芬太尼血浆靶控输注,丙泊酚和瑞芬太尼分别采用Marsh和Minto药代动力学模型;MCI组采用丙泊酚、瑞芬太尼静脉注射诱导和持续静脉滴注维持,两组均于诱导插管前应用一次肌松药,之后不再使用。两组麻醉过程中均维持血流动力学平稳和全身麻醉深度稳定。主要比较两组对全身麻醉深度调控的便利性和关键手术步骤脑电双频指数的波动幅度,同时观察丙泊酚和瑞芬太尼药物用量、血流动力学变化、术毕清醒和拔管时间,以及对脊髓电生理监测成功率的影响。结果:TCI组静脉泵调控次数小于MCI组,差异有统计学意义(P<0.05);TCI组关键手术步骤脑电双频指数(bispectral index,BIS)波动幅度小于MCI组,差异有统计学意义(P<0.05)。TCI组与MCI组丙泊酚(P=0.158)和瑞芬太尼(P=0.168)在脊柱后凸矫正手术中的总药量差异无统计学意义,术毕清醒时间(P=0.972)和拔管时间(P=0.944)差异无统计学意义,脊髓电生理监测成功率,差异无统计学意义(P﹥0.05)。结论:TCI和MCI均可为脊柱后凸畸形矫正手术提供满意麻醉,TCI组对全身麻醉深度调节更为便利、稳定。

Objective：To compare anesthesia profiles of target-controlled infusion （TCI） and manual- controlled infusion （MCI） of propofol and remifentanil in kyphosis correction or scoliosis correction sur- gery, in which intraoperative spinal cord monitoring was employed. Methods： In the study, 160 patients scheduled for kyphosis correction surgery or scoliosis correction were enrolled and randomly allocated into 2 groups, group TCI and group MCI. In group TCI, induction and maintenance of general anesthesia were carried out by target-controlled infusion of propofol and remifentanil. Marsh and Minto, three-com- partment pharmacokinetic models for propofol and remifentanil were used respectively. In group MCI, the patients received propofol and remifentanil by conventional dose-weight infusion method. Muscle relaxants were only applied for ease of induction. In both the groups, anesthesia depth was monitored by bispectral index （BIS） , and the change of hemodynamie parameters was kept in the range of 20% of the baseline. The control convenience of anesthesia depth and change amplitude of BIS in the main steps of the procedure were compared. The total amounts of propofol and remifentanil, influence on the hemodynamics, in- fluence on the successful rates of somatosensory evoked potentials （SSEPs） and motor evoked potentials （MEPs） and eleetromyography （EMG） were compared too. Results： The time of pump regulation in group TCI was significantly less than in group MCI （P 〈 0.05 ）. The BIS fluctuation in the main steps of the procedure was significantly smaller in Group TCI than in group MCI （P 〈 0.05 ）. There was no significant difference in the amounts of propofol and remifentanil（P = 0. 158 and P = 0. 168）. The time to awake （P = 0. 972 ） and time to extubation （P = 0. 944） had no significant difference. The successful rates of SSEPs and MEPs had no significant difference between groups TCI amd MCI （ P 〉 0.05）. Conclusion ： Both TCI and MCI can offer practical anesthesia for spinal deformity correction surgery. TCI has the advantage in keeping smooth and steady depth of anesthesia.