地氟醚和七氟醚对术中运动诱发电位监测的影响

Comparison of the effects of desflurane and sevoflurane on intraoperative motor evoked potentials

目的比较地氟醚和七氟醚对术中运动诱发电位（motor evoked potentials,MEPs）监测的影响。方法选择ASAⅠ或Ⅱ级,择期神经外科手术术中行MEPs监测的患者36例,随机均分为两组：地氟醚组（F组）和七氟醚组（S组）。术中监测血流动力学、BIS、MEPs的波幅和潜伏期、肌松（TOF值）、体温。术中保证肌松药作用消失,维持血流动力学平稳,BIS 40-60,体温36-37℃,调节吸入麻醉药浓度,使其呼气末浓度达到0.7、0.8、0.9和1.0 MAC,每一浓度维持10min,测每一浓度下四肢的运动诱发电位,记录其潜伏期和波幅,比较两组各肢体在不同浓度下MEPs的潜伏期和波幅的变化。结果与前一MAC比较,随MAC值增加,左上、下肢体和右上、下肢体的两组MEPs潜伏期明显延长,MEPs波幅明显降低（P〈0.05）。在0.7、0.8 MAC时,左下肢和右下肢F组的MEPs潜伏期明显长于,MEPs波幅明显低于S组（P〈0.05）;在0.9、1.0 MAC时,左上、下肢体和右上、下肢体的F组的MEPs潜伏期明显长于,MEPs波幅明显低于S组（P〈0.05）。与前一MAC比较,随MAC值增加,左上、下肢体和右上、下肢体的两组MEPs潜伏期与0.7 MAC时MEPs潜伏期的百分率明显升高,MEPs波幅与0.7 MAC时MEPs波幅的百分率明显减低（P〈0.05）。结论地氟醚和七氟醚对MEPs均有抑制作用,随着药物浓度的增加,抑制作用逐渐增强,且在同一MAC条件下,似乎地氟醚的抑制作用强于七氟醚。

Objective To compare the impact of desflurane and sevoflurane on intraoperative motor evoked potentials monitoring.Methods Thirty-six ASA Ⅰ orⅡ patients scheduled for neurosurgery with intraoperative MEPs monitoring were randomly divided into two groups（n=18each）：desflurane group（group S）and sevoflurane group（group F）.Intraoperative hemodynamics,bispectral index（BIS）,MEPs amplitude and latency,muscle relaxants（TOF value）and body temperature was monitored.When intraoperative muscle relaxant effects disappeared,stable hemodynamics,BIS40-60 and temperature 36-37 was maintained in each group.The latency and amplitude of MEPs were recorded when the end-tidal concentration of inhaled anesthetics was 0.7,0.8,0.9and 1.0MAC respectively.Results The latency of MEPs prolonged and the amplituded decreased along with the MAC increased（P〈0.05）.Compared with group S, the latency of MEPs was significantly longer and the amplitude was significantly lower in group F in both lower limbs of 0.7,0.8MAC（P〈0.05）and in all limbs of 0.9,1.0MAC（P 〈0.05）.Conclusion Desflurane and sevoflurane could dose-dependently inhibit MEPs monitoring,and the inhibitory effect of desflurane was stronger than that of sevoflurane.