不同剂量顺式阿曲库铵对神经外科手术患者体感诱发电位联合运动诱发电位监测的影响

Effects of Different Doses of Cis-atracurium on the Monitoring of Somatosensory Evoked Potentials Combined with Motor Evoked Potentials in Patients Undergoing Neurosurgery

目的研究不同剂量顺式阿曲库铵对神经外科手术患者体感诱发电位(somatosensory evoked potentials, SEP)联合运动诱发电位(motor evoked potentials, MEP)监测的影响。方法选取河北省人民医院2015年4月—2017年6月收治的93例择期行全身麻醉SEP联合MEP监测的脑肿瘤手术患者,按照顺式阿曲库铵注射剂量的不同分为A组、B组及C组各31例。在麻醉诱导后5 s内单次静脉推注不同剂量的顺式阿曲库铵,其中A组为0.15 mg/kg,B组为0.20 mg/kg,C组为0.25 mg/kg。观察记录各组患者入室(T0)、气管插管即刻(T1)、停肌松药即刻(T2)、停肌松药后30 min(T3)时心率、平均动脉压及脑电双频指数(BIS)水平;比较各组患者术中丙泊酚用量、MEP及SEP监测情况;并记录各组患者术中不良反应发生情况。结果 B、C组患者T1～T3时心率、平均动脉压均明显高于T0时,BIS均明显低于T0时,差异均有统计学意义(P<0.05);A组患者T1～T3时心率、平均动脉压与T0时比较差异无统计学意义(P>0.05),但BIS明显低于T0时,差异有统计学意义(P<0.05);A组患者T1～T3时心率与平均动脉压均明显低于B、C组患者,差异有统计学意义(P<0.05);A组患者T1～T3时BIS与B、C组患者比较差异无统计学意义(P>0.05)。A组患者术中丙泊酚使用剂量少于B、C组患者,引发MEP等待时间短于B、C组患者,引发MEP电流强度低于B、C组患者,差异均有统计学意义(P<0.01);3组患者T3时N20-P25波幅及N20潜伏期比较差异均无统计学意义(P>0.05)。A组患者术中不良反应发生率明显低于B、C组患者,差异有统计学意义(P<0.05)。结论神经外科手术患者全麻诱导时使用0.15 mg/kg顺式阿曲库铵可以有效降低对SEP与MEP监测的影响,维持血流动力学稳定,同时减少术中丙泊酚使用量,降低术中不良反应发生率,安全性较好。

Objective To investigate the effects of different doses of cis-atracurium on the monitoring of somatosensory evoked potentials (SEP) combined with motor evoked potentials (MEP) in patients undergoing neurosurgery. Methods We selected 93 patients with brain tumor who were admitted to Hebei General Hospital from April 2015 to June 2017 and underwent elective surgery under general anesthesia with SEP monitoring combined with MEP monitoring. According to the different doses of cis-atracurium, they were divided into group A ( n =31), group B ( n = 31) and group C ( n =31). A single intravenous injection of different doses of cis-atracurium was given within 5 s after anesthesia induction, with 0.15 mg/kg in group A, 0.20 mg/kg in group B, and 0.25 mg/kg in group C.The heart rate (HR), mean arterial pressure (MAP) and the level of bispectral index (BSI) of the patients in each group were observed and recorded at the time of entering the room (T0), immediately after tracheal intubation (T1), immediately after muscle relaxant withdrawal (T2) and 30 min after muscle relaxant withdrawal (T3). The intraoperative propofol dosage, MEP and SEP monitoring were compared between the groups, and the incidence of adverse reactions during operation was recorded. Results In group B and C, HR and MAP at T1-3 were significantly higher than those at T0 and the BIS was significantly lower than that at T0 ( P <0.05).There was no significant difference in HR and MAP at T1-3 and T0 ( P >0.05). However, the BIS at T1-3 was significantly lower than that at T0 ( P <0.05). HR and MAP of patients at T1-3 in group A were significantly lower than those in group B and C ( P <0.05).There was no significant difference in BIS at T1-3 between group A and group B, C ( P >0.05).The intraoperative dose of propofol, the waiting time of initiating MEP and the intensity of initiating MEP in group A were significantly lower than those in group B and C ( P <0.01). There was no significant difference in the N20-P25 amplitude and N20 latency between the three groups at T3 ( P >0.05). The incidence of adverse reactions in group A was significantly lower than that in group B and C ( P <0.05). Conclusion The use of 0.15 mg/kg cis-atracurium in general anesthesia in patients undergoing neurosurgery can effectively reduce the impact on monitoring of SEP combined with MEP, and maintain hemodynamic stability. It also reduces the amount of propofol used during surgery as well as the incidence of adverse reactions during surgery as a safe approach.