不同麻醉方式在腮腺肿瘤切除术时面神经监测中的应用比较

Application of different anesthesia methods in facial nerve monitoring during parotid gland surgery

目的:比较静吸复合麻醉与全凭静脉麻醉用于腮腺肿瘤切除术时面神经监测的临床效果及安全性。方法:70例接受腮腺肿瘤切除手术的患者,随机分为静吸复合组(S组)和全凭静脉组(V组)(n=35)。麻醉诱导时静脉给予顺式阿曲库铵0.15 mg/kg,气管插管后S组吸入七氟醚复合泵注丙泊酚+瑞芬太尼维持,V组则仅泵注丙泊酚+瑞芬太尼维持。使用肌松监测仪测定拇指内收肌的4个成串刺激(TOF)反应,记录阻滞起效时间、深度阻滞恢复时间(T1的出现时间)、T150%及TOF 90%恢复时间。术中采用面神经电生理监测,记录2组患者在T150%时监测的成功率,比较2组患者术中发生体动与心血管药物使用情况及术后拔管时间。采用SPSS 20.0软件包对数据进行统计学分析。结果:2组患者肌松起效时间无显著差异(P>0.05),S组T1的出现时间晚于V组,但组间差异无统计学意义(P>0.05),S组的T150%及TOF 90%恢复时间显著延长(P<0.05)。2组患者在T150%时均能成功获得面神经监测信号。2组均无使用血管活性药物的患者;V组有2例患者术中发生轻微体动。2组患者拔管时间无显著差异(P>0.05)。结论:静吸复合麻醉和全凭静脉麻醉均能满足术中面神经监测的手术要求,全凭静脉麻醉有利于更早地获得面神经电生理信号,而静吸复合麻醉有利于预防术中体动发生。

PURPOSE:To compare the effects of intravenous inhalation anesthesia and total intravenous anesthesia in facial nerve monitoring without muscle relaxant during resection of parotid tumors. METHODS: Seventy patients with parotid tumors undergoing facial nerve monitoring surgery were randomly divided into 2 groups, with 35 cases in each group. After cisatracurium administration, maintenance of anesthesia was performed by sevoflurane plus remifentanil and propofol in group sevofurane(S) and propofol plus remifentanil in group vein(V). Train-of-four ratio(TOF) was monitored and block work time, recovery time of deep blockade T1, T1 50% and TOF 90% were recorded. Electrophysiological monitor was connected and the success rates of facial nerve monitoring in the recovery time of T1 50% were compared. The response of body movement, usage of vasoactive agents and extubation time were also recorded. SPSS 20.0 software pack-age was used for data analysis. RESULTS: There was no significant difference in time of block work and recovery time of deep blockade between two groups(P>0.05). Recovery time of T1 50% and TOF 90% in group S were significantly longer than those in group V(P<0.05). All patients underwent electrophysiological monitor successfully in the recovery time of T1 50%. Two patients in group V had weak body movements during operation,and patients in both groups had no cardiovascular drug treatments. There was no significant difference between the two groups in time of extubation(P>0.05). CONCLUSIONS:The two methods in facial nerve monitoring without muscle relaxant during resection of parotid tumors are com-pletely possible and effective. Sevoflurane can enhance the muscle relaxation of cisatracurium and the patients undergoing total intravenous anesthesia can receive electrophysiological signals of facial nerve earlier. Intravenous inhalation anesthe-sia provides lower movements.