全凭静脉麻醉与静-吸复合麻醉下腰椎手术中神经电生理监测的比较

Comparison of the effects of total intravenous anesthesia or intravenous-inhalation combined anesthesia on intraoperative neurophysiological monitoring in spinal surgery

目的：比较全凭静脉麻醉与静-吸复合麻醉在腰椎手术中对体感诱发电位（SSEP）及运动诱发电位（MEP）的影响。方法选择择期行全麻腰椎手术患者60例，随机均分为两组，每组30例。麻醉维持时 T 组丙泊酚 TCI 血浆靶浓度为3.0～3.5μg／ml，I 组吸入1％七氟醚复合丙泊酚泵注，两组均维持 BIS 在40～50。记录清醒时（T0）、插管后5 min（T1）、切皮时（T2）以及椎管减压时（T3）的 SSEP 和 MEP 等相关参数，并记录运动诱发电位未引出情况。结果与 T0时比较，T1～T3时两组 P38、N45波潜伏期明显延长（P＜0.05），波幅明显降低（P＜0.05），但组间差异无统计学意义。两组无一例出现术中单侧或双侧下肢的 MEP 消失。结论与单纯丙泊酚全凭静脉麻醉比较，复合1％七氟醚麻醉并不影响腰椎手术中 SSEP 及 MEP 的监测，可用于行神经电生理监测的脊柱手术。

Objective To compare the effects of total intravenous anesthesia or Intravenous-in-halation combined anesthesia on intraoperative somatosensory evoked potential （SSEP）and motor evoked potential （MEP）in spinal surgery.Methods Sixty patients scheduled for spinal surgery under general anesthesia were divided randomly and equally into 2 groups.The anesthesia was maintained with TCI propofol （plasma target concentration 3.0-3.5 μg/ml）and 1% sevoflurane＋propofol in group T or group I respectively.BIS was monitored and maintained at 40-50.SSEP and MEP was re-corded before induction of anaesthesia （T0 ）,5 minutes after tracheal intubation （T1 ）,during skin in-cision （T2 ）and at the time of decompressing spinal canal （T3 ）.Results The latency of P38 and N45 prolonged,and the amplitudes of P38 and N45 was significantly depressed at T1-T3 compared to those at T0 （P ＆lt;0.05）.No statistically significant differences in cortical SSEP amplitudes or latency was observed in each time point.There was no case who could not detect the wave of MEP intraoperative-ly in this study.Conclusion The data from these cases indicates that 1% sevoflurane can be used in conjunction with SSEP and MEP monitoring for some adult patients undergoing spinal surgery.