甲状腺手术中追加肌松药对神经监测的影响

Effect of add to muscle relaxants on nerve monitoring in thyroid surgery

目的比较甲状腺手术中追加肌松药物对术中神经监测的影响,为甲状腺手术神经监测提供参考。方法选取2021年3月至2021年6月河南省人民医院同一外科医师团队甲状腺手术喉返神经监测患者80例,随机分为A、B两组,两组患者均采用相同的麻醉诱导药物及肌松药物,均由资深麻醉医师完成神经监测气管插管。手术开始后待暴露迷走神经时,采用NIM-Response 3.0神经肌电监测仪监测,以3 mA电流刺激迷走神经,待有持续稳定肌电信号后,A组患者嘱麻醉医师加深麻醉,不追加肌松药物;B组患者开始给予顺式阿曲库铵微量泵持续泵入直至手术结束,其他麻醉药物维持原量。记录两组患者迷走神经和喉返神经肌电信号各时间段相应值;术中体动及呛管次数、术中血压、心率波动、苏醒延迟、恶心呕吐及颈部僵硬不适等并发症。组间比较采用t检验、秩和检验及χ^(2)检验。结果 A组患者术中5例出现呛管体动,B组0例,差异有统计学意义(χ^(2)=3.413,P<0.05);两组患者术中均能实时监测神经肌电信号,两组振幅分别为A组(355±125)、(482±136)、(580±156) μV,B组(382±132)、(468±118)、(620±163) μV,差异无统计学意义(t=0.655、0.326、0.596,P>0.05);B组患者较A组术中心率、血压更加平稳,术后恶心呕吐、颈部僵硬不适感、苏醒延迟等并发症相对较少,分别为A组6、5、2例,B组3、2、1例,差异无统计学意义(χ^(2)=1.126、1.409、0,P>0.05)。结论甲状腺手术中小剂量持续泵入肌松药物对术中神经监测无明显影响,更有利于手术的安全进行及患者术后的康复。

Objective To compare the effect of additional muscle relaxants on intraoperative nerve monitoring in thyroid surgery,so as to provide reference for nerve monitoring in thyroid surgery.Methods From March 2021 to June 2021,80 patients with recurrent laryngeal nerve monitoring in thyroid surgery of the same surgeon team in our hospital were randomly divided into group A and group B.the patients in the two groups were given the same anesthesia induction drugs and muscle relaxants,and the senior anesthesiologists completed the nerve monitoring tube intubation.After the operation,when the vagus nerve was exposed,NIM-response 3.0 electromyographic monitor system was used to monitor.The vagus nerve was stimulated with 3 mA current.After the continuous and stable myoelectric signal was obtained,the patients in group A asked the anesthesiologist to deepen the anesthesia without additional muscle relaxants;Patients in group B were given cisatracurium micropump continuously until the end of the operation,and other anesthetic drugs were maintained in the original amount.The corresponding values of vagus nerve and recurrent laryngeal nerve in each time period were recorded;Intraoperative body movement,intraoperative blood pressure,heart rate fluctuations,delayed awakening,nausea and vomiting and other complications.Differences between groups were analyzed by t test,rank sum test andχ^(2) test.Results In group A,5 cases had intraoperative movement,while 0 cases in group B,the difference between the two groups had statistical significance(χ^(2)=3.413,P<0.05).The nerve electromyogram(EMG)signals could be monitored in real timeIn both groups,The amplitude of the two groups,A(355±125),(482±136),(580±156)μV,B(382±132),(468±118),(620±163)μV,There was no significant difference between the two groups(t=0.655,0.326,0.596,P>0.05);Compared with group A,the rate and blood pressure of group B were more stable,and postoperative nausea and vomiting,neck stiffness and discomfort were relatively less,there were 6,5 and 2 cases in group A and 3,2 and 1 cases in group B,with no statistical significance(χ^(2)=1.126,1.409,0,P>0.05).Conclusion Small dose of muscle relaxant in thyroid surgery has no effect on intraoperative nerve monitoring,and is more conducive to the safety of operation and postoperative rehabilitation.