不同剂量罗库溴铵对椎管减压植骨融合内固定术术中神经电生理监测的影响

Effects of different doses of rocuronium bromide on the intraoperative neurophysiological monitoring during decompression bone grafting fusion internal fixation

目的探讨不同剂量罗库溴铵对脊柱外科行椎管减压植骨融合内固定术的患者术中神经电生理监测的影响。方法择期行椎管减压植骨融合内固定手术的患者63例,男36例,女27例,年龄18~65岁,ASAⅠ或Ⅱ级,采用随机数字表分为三组,每组21例:A组、B组、C组肌松维持时罗库溴铵泵注剂量分别为6、9、12μg·kg-1·min-1。记录获得基础电位时(T 1)、椎弓根螺钉置入前1 min(T 2)、椎管减压前1 min(T 3)的体感诱发电位(SEP)及运动诱发电位(MEP)的波幅,以及术中意外体动、自主呼吸恢复及舌咬伤等情况。结果A组、B组和C组SEP波幅差值差异无统计学意义。与A组比较,B组右上肢T 2时MEP波幅与T 1时MEP波幅差值明显减小(P<0.05),右上肢及右下肢T 3时MEP波幅与T 1时MEP波幅差值明显减小(P<0.05);C组双上肢T 2时MEP波幅与T 1时MEP波幅差值明显减小(P<0.05),双上肢及右下肢T 3时MEP波幅与T 1时MEP波幅差值明显减小(P<0.05)。与B组比较,C组左上肢T 3时MEP波幅与T 1时MEP波幅差值明显减小(P<0.05)。A组有5例(24%)在术中出现意外体动,B组、C组无一例意外体动(P<0.05)。A组有1例(5%)出现舌咬伤,B组、C组无一例舌咬伤。三组均未出现自主呼吸恢复的情况。结论椎管减压植骨融合内固定术中罗库溴铵最佳维持剂量为9μg·kg-1·min-1。

Objective To explore the effects of different doses of rocuronium bromide on intraoperative neurophysiological monitoring during decompression bone grafting fusion internal fixation.Methods Sixty-three patients decompression bone grafting fusion internal fixation,36 males and 27 females,aged 18-65 years,falling into ASA physical statusⅠorⅡ,were selected for this study.According to the random number table,they were divided into 3 groups(21 cases in each group).The pumping doses of rocuronium bromide in group A,group B,and group C were 6,9,and 12μg·kg-1·min-1,respectively.The amplitude of somatosensory evoked potential and motor evoked potential were recorded when the basic potential was obtained(T 1),1 min before pedicle screw placement(T 2),and 1 min before spinal canal decompression(T 3).The occurrence of accidental body movement,spontaneous breathing recovery and tongue bite were recorded.Results The differences of SEP amplitude among group A,group B and group C were not statistically significant.Compared with group A,the amplitude difference values of right upper limbs in group B between T 2 and T 1 were decreased(P<0.05),the amplitude difference values of both right limbs in group B between T 3 and T 1 were decreased(P<0.05).Compared with group A,the amplitude difference values of both upper limbs in group C between T 2 and T 1were decreased(P<0.05),the amplitude difference values of both upper limbs and right lower limbs in group C between T 3 and T 1 were decreased(P<0.05).Compared with group B,the amplitude difference values of left upper limbs in group C between T 3 and T 1 were decreased(P<0.05).In group A,5 patients(24%)had accidental body movement during the operation,while in group B and C,no accidental body movement occurred during the whole process(P<0.05).Tongue bite was found in 1 patient(5%)in group A,and no tongue bite was found in group B and group C,but the difference was not statistically significant.None of the patients in the three groups showed spontaneous respiratory recovery.Conclusion The optimal maintenance dose of the muscle relaxant in the spinal canal decompression bone graft fusion internal fixation is pumping rocuronium 9μg·kg-1·min-1 when the muscle relaxant is maintained.