右美托咪定对颈椎手术摆体位过程中体感诱发电位监测的影响

Effect of dexmedetomidine on the monitoring of somatosensory evoked potential during positioning of cervical spine surgery

目的观察右美托咪定对颈椎手术摆体位过程中体感诱发电位(SEP)监测的影响。方法选择全身麻醉下择期行颈椎手术的患者45例,随机分为D组(右美托咪定组)23例,C组(对照组)22例。2组患者使用丙泊酚4~6 mg/(kg·h)、瑞芬太尼12~30μg/(kg·h)持续泵入维持麻醉,其中D组诱导前持续泵注负荷剂量1μg/kg右美托咪定10 min后,术中持续泵注维持剂量0.4μg/(kg·h)的右美托咪定至术毕,C组采用相同剂量的生理盐水泵注至术毕。2组患者BIS值维持在35~60,记录2组患者清醒时(T_(0))、负荷剂量泵注结束时(T_(1))、麻醉诱导后(T_(2))、插管后(T_(3))、摆体位后(T_(4))5个时间点SEP的波幅(N13~P15、N45~P37)、潜伏期(N13、P15、N45、P37)以及心率(HR)、平均动脉压(MAP)、体温(T)、脑电双频指数(BIS)值;记录2组患者术中丙泊酚、瑞芬太尼用量,比较2组患者术前、术后第7天JOA评分。结果2组患者比较N13~P15波幅差异无统计学意义(P>0.05);2组间N45~P37波幅在T_(4)时间点差异有统计学意义(P<0.05)。2组患者4个潜伏期组间比较差异均无统计学意义(P>0.05)。MAP、HR、T、BIS组间比较差异均无统计学意义(P>0.05)。2组患者术中丙泊酚、瑞芬太尼用量比较差异均无统计学差异(P>0.05)。2组患者术前和术后第7天JOA评分比较差异均无统计学意义(P>0.05)。结论右美托咪定可以减少颈椎手术摆体位过程中诱发电位波幅的下降,预防和降低体位改变时的脊髓损伤。

Objective To observe the effects of dexmedetomidine on somatosensory evoked potential monitoring(SEP)during cervical spine surgery.Methods Forty-five patients undergoing cervical spine surgery were randomly divided into group D(dexmedetomidine group,n=23)and group C(control group,n=22).Both groups of patients were continuously pumped with propofol[4~6 mg/(kg·h)]and remifentanil[12~30μg/(kg·h)]to maintain anesthesia.The patients in group D were continuously pumped with a loading dose of dexmedetomidine(1μg/kg)before induction,after 10 minutes,the maintenance dose was 0.4μg/(kg·h)dexmedetomidine was injected to the end of operation,and the same dose of saline were pumped to the end of operation in the patients of group C.The bispectral index(BIS)of the two groups were maintained at 35-60.Somatosensory evoked potential monitoring was performed during five stages of the procedure:awaking(T_(0)),before induction of anesthesia(T_(1)),after induction of anesthesia(T_(2)),after intubation(T_(3)),and after positioning(T_(4)).The heart rate(HR),mean arterial pressure(MAP),body temperature(T),bispectral index(BIS)at these five time points were recorded.The intraoperative doses of propofol and remifentanil were recorded.The scores of the Japanese Orthopaedic Association(JOA score)before and on the seventh day after surgery between the two groups were compared.Results There was no significant difference in N13-P15 amplitude between the two groups(P>0.05).There was significant difference in N45-P37 amplitude between the two groups at the T4 time point(P<0.05).The four latencies between the two groups were not statistically significant(P>0.05).There was no statistical difference among the MAP,HR,T,and BIS groups(P>0.05).There was no significant difference of intraoperative propofol and remifentanil dosages between the two groups(P>0.05).There was no significant difference in JOA score between the two groups before operation and the seventh day after operation(P>0.05).Conclusion Dexmedetomidine can reduce the drop of evoked potential amplitude during positioning of cervical spine surgery,and reduce spinal cord injury during the body position changes.