不同剂量顺式阿曲库铵对神经外科手术运动诱发电位的影响

Effects of different doses of cisatracurium on motor evoked potential of neurosurgery operation

目的探讨不同剂量顺式阿曲库铵对神经外科手术运动诱发电位(motor evoked potentials,MEPs)的影响。方法选择择期行MEPs监测的脊髓脊柱手术患者60例,男36例,女24例,年龄18~65岁,ASAⅠ或Ⅱ级。随机分为三组,在麻醉诱导后5s内单次静脉推注顺式阿曲库铵0.1mg/kg(A组)、0.15mg/kg(B组)和0.2mg/kg(C组),采用Cascade Elite 32通道监测仪进行MEPs监测,给肌松药后每隔2分钟刺激电极1次,记录引出MEPs波形的时间。采用Cooper评分法评价气管插管条件。结果 C组引出MEPs波形的时间明显长于A组[(39.60±1.79)min vs.(20.10±1.89)min,P<0.05],C组引出MEPs波形的时间明显长于B组[(39.60±1.79)min vs.(20.50±1.93)min,P<0.05]。B组气管插管条件明显优于A组(100%vs.65%,P<0.05),C组气管插管条件明显优于A组(100%vs.65%,P<0.05)。结论全麻诱导使用顺式阿曲库铵0.15mg/kg引出MEPs波形所需时间短,气管插管条件较优,是行MEPs监测的神经外科手术麻醉诱导中较合适的顺式阿曲库铵剂量。

Objective To determine the effects of different doses of cisatracurium on motor evoked potential of neurosurgery operation.Methods Sixty patients,36 males and 24 females,aged18to 65 years,ASA physical statusⅠ orⅡ,scheduled for spinal surgery with motor evoked potential monitoring,were included and randomly assigned to three groups.A single dose of cisatracurium besilate for injection was given by intravenous injection in 5safter the induction of general anesthesia,respectively 0.1mg/kg（group A）,0.15mg/kg（group B）and 0.2mg/kg（group C）.Cascade Elite32 channel monitor was used to monitor MEPs,the electrode was stimulated for once two minutes after given the muscle relaxant,and the leading time of the wave of MEPs was recorded.Cooper＇s score was used to evaluate the intubation conditions.Results The appearance time of the wave of motor evoked potentials was significantly longer in group C [（39.60±1.79）min]than that in groups A[（20.10±1.89）min]and B[（20.50±1.93）min]（P〈0.05）.The intubation conditions was significantly better in group B（100%）and C（100%）than that in group A（65%）（P〈0.05）.Conclusion The shortest time to elicit waveform of MEPs using the dose of cisatracurium is 0.15mg/kg at induction of general anesthesia,which is better for tracheal intubation.The dose 0.15mg/kg of cisatracurim is recommended as the initial dose on neurosurgery operation with motor evoked potential monitoring.