脊髓脊柱手术中持续静脉泵注顺式阿曲库铵对运动诱发电位影响研究

Effects of Continuous Infusion of Cisatracurium via an Infusion Pump during the Maintenance Phase of General Anesthesia on Motor-evoked Potentials in Spinal Cord Surgery

目的探讨脊髓脊柱手术中全身麻醉维持阶段持续静脉泵注顺式阿曲库铵对运动诱发电位(MEPs)的影响,为术中行MEPs监测合理使用肌松药提供依据。方法选取2015年3月—2016年3月石河子大学医学院第一附属医院行MEPs监测的择期脊髓脊柱手术患者50例为研究对象,采用随机数字表法将患者分为对照组及试验组,每组25例。两组患者均采用美国Nicolet公司的Cascade Elite 32通道监测仪进行MEPs监测。试验组在麻醉诱导后持续静脉泵注顺式阿曲库铵,维持肌松使4个成串刺激后单次颤搐100%被抑制的时间在45%~55%。对照组在麻醉诱导后于5 s内单次静脉推注0.15 mg/kg顺式阿曲库铵,术中不再使用。观察并记录清醒时和术中整个过程两组MEPs波幅与潜伏期变化情况,麻醉前即基础值(T0)、气管插管即刻(T1)、手术30 min(T2)和手术120 min(T3)平均动脉压(MAP)、心率,手术时间、术中脑电双频指数(BIS)值、气道压、术后苏醒时间、拔管时间。结果清醒时,试验组与对照组MEPs波幅和潜伏期比较,差异均无统计学意义(P>0.05)。术中,试验组MEPs波幅较对照组降低(P<0.05);试验组与对照组MEPs潜伏期比较,差异无统计学意义(P>0.05)。对照组清醒时与术中MEPs波幅和潜伏期比较,差异均无统计学意义(P>0.05)。试验组术中MEPs波幅较清醒时降低(P<0.05);试验组清醒时与术中MEPs潜伏期比较,差异无统计学意义(P>0.05)。治疗方法与时间在MAP和心率上不存在交互作用(P>0.05);治疗方法在MAP和心率上主效应显著(P<0.05);时间在MAP和心率上主效应显著(P<0.05)。试验组与对照组患者手术时间、术中BIS值、气道压及术后苏醒时间比较,差异均无统计学意义(P>0.05);试验组患者拔管时间较对照组延长(P<0.05)。两组患者均无术中知晓。结论脊髓脊柱手术中全身麻醉维持阶段不持续静脉泵注顺式阿曲库铵对MEPs的影响小,更有利于MEPs监测。

Objective To investigate the effect of continuous infusion of cisatracurium via an infusion pump during the maintenance phase of general anesthesia on motor-evoked potentials（MEPs） in spinal cord surgery,in order to provide anevidence for rational use of muscle relaxants for MEPs monitoring during this kind of surgery.Methods Fifty patients undergoing elective spinal cord surgery with MEPs monitoring in the First Affiliated Hospital of the Medical College,Shihezi University,from March 2015 to March 2016 were enrolled and divided into control group and experimental group according to random number table with 25 in each.The 32-Channel Cascade Elite produced by Nicolet Company in America was used to monitor MEPs in both groups.The experimental group received continuous infusion of cisatracurium via an infusion pump after the induction of general anesthesia for maintaining muscle relaxation and keeping the T1 values of TOF within 45%-55%.In the control group,intravenous injection of cisatricurium 0.15 mg/kg was given at 5 s after general anesthesia induction and no longer used during the surgery.The amplitude and latency of MEPs during the surgery and emergence from anesthesia,mean arterial pressure（MAP） and heart rate at baseline（T0）,immediately after tracheal intubation（T1）,at 30 minutes（T2）,and 120 minutes after incision（T3）,the duration of surgery,intraoperative BIS value and airway pressure,emergence time,and extubation time were recorded.Results The amplitude and latency of MEPs during emergence from anesthesia did not differ significantly between the two groups（P〉0.05）.During the surgery,the amplitude of MEPs was significantly lower in the experimental group than that in the control group（P〈0.05）,but the latency of MEPs in both groups was similar（P〉0.05）.The control group did not demonstrate significant changes in their amplitude and latency of MEPs during the surgery and emergence from anesthesia（P〉0.05）.As for the experimental group,the amplitude of MEPs during the surgery was much lower than that in emergence from anesthesia（P〈0.05）,but the latency of MEPs measured under both conditions was similar（P〉0.05）.Administration method and duration of cisatracurium had no obvious interaction effects on MAP and heart rate（P〉0.05）,but each of them produced significant main effects on MAP and heart rate（P〈0.05）.Both groups had no significant differences in terms of the duration of surgery,intraoperative BIS value,airway pressure and emergence time from anesthesia（P〉0.05）.The experimental group was found with prolonged extubation time（P〈0.05）.Both groups had no intraoperative awareness.Conclusion During the maintenance phase of general anesthesia in spinal cord surgery,abandoning the use of cisatracurium has smaller effect on MEPs and might be a more favorable way for MEPs monitoring.