右美托咪定对特发性脊柱侧弯矫形术中体感诱发电位和运动诱发电位的影响

Effects of dexmedetomidine on somatosensory evoked potentials and motor evoked potentials during idiopathic scoliosis surgery

目的研究右美托咪定(dexmedetomidine,Dex)对特发性脊柱侧弯矫形术中体感诱发电位(somatosensory evoked potentials,SEPs)和经颅电刺激运动诱发电位(transcranial electric motor evoked potentials,TCeMEPs)的影响。方法选择拟在全麻下行脊柱侧弯矫形术的患者60例,Cobb角60°~100°,ASA分级Ⅰ、Ⅱ级,按随机数字表法分为两组(每组30例):右美托咪定组(D组)和对照组(C组)。D组于麻醉诱导开始即微量泵注Dex负荷量1μg·kg^(−1)·h^(−1),持续10 min后减至0.4μg·kg^(−1)·h^(−1)直至手术结束前2 h停止;C组给予等体积生理盐水。观察记录患者入手术室时(T_(0))、Dex负荷剂量结束时(T_(1))、Dex泵注30 min时(T_(2))、Dex泵注60 min时(T_(3))、Dex泵注90 min时(T_(4))的MAP、心率、SpO_(2),患者年龄、手术时间、出血量、苏醒时间、拔管时间和Ramsay镇静评分,术中SEPs、TCeMEPs波幅和潜伏期变化情况。结果两组患者年龄、手术时间比较差异无统计学意义(P>0.05)。与C组比较,D组患者出血量减少,苏醒时间、拔管时间明显延长,Ramsay镇静评分提高(P<0.05)。两组患者T0时点MAP、心率比较差异无统计学意义(P>0.05);与C组比较,D组患者T_(1)、T_(2)、T_(3)和T_(4)时点MAP、心率明显降低(P<0.05)。两组患者各时点SpO_(2)差异无统计学意义(P>0.05)。与C组比较,D组SEPs和TCeMEPs波幅和潜伏期变化发生率差异无统计学意义(P>0.05)。结论Dex用于特发性脊柱侧弯矫形术时对SEPs和TCeMEPs无影响,可降低MAP减少术中出血利于术者操作,还可减慢心率维持循环稳定,同时减少患者苏醒期躁动发生。

Objective To investigate the effects of dexmedetomidine(Dex)on somatosensory evoked potentials(SEPs)and transcranial electric motor evoked potentials(TCeMEPs)during idiopathic scoliosis orthopedic surgery.Methods A total of 60 patients,Cobb angle 60°-100°,American Society Anesthesiologists(ASA)ⅠorⅡ,who underwent idiopathic scoliosis orthopedic surgery under general anesthesia were enrolled.According to the random number table method,they were divided into two groups(n=30):a Dex group(group D)and a control group(group C).Patients in group D were injected with Dex using a micro-pump at a load-dose of 1μg·kg^(−1)·h^(−1) at the beginning of anesthesia induction for 10 min,and then reduced to 0.4μg·kg^(−1)·h^(−1) till 2 h before the end of surgery,while the same volume of normal saline was given to patients in group C.Their mean arterial pressure(MAP),heart rate,pulse oxygen saturation(SpO_(2)),recovery time,extubation time and Ramsay sedation score,and SEP and TCeMEP changes in amplitude and latency were recorded at the following time points:when entry into the operation room(T_(0)),at the end of Dex loading dose(T_(1)),when micro-pump injection of Dex for 30 min(T_(2)),60 min(T_(3)),90 min(T_(4)).Results There was no significant difference in age,operation time between the two groups(P>0.05).Compared with group C,patients in group D presented less blood loss,prolonged recovery time and extubation time,and increased Ramsay sedation score(P<0.05).There was no significant difference in MAP and heart rate between the two groups at T0(P>0.05).Compared with group C,group D showed significant decreases in MAP and heart rate at T_(1),T_(2),T_(3) and T4(P<0.05).There was no significant difference in SpO_(2) between the two groups at each time point(P>0.05).Compared with group C,no statistical difference was found in the amplitude and latency of SEPs and TCeMEPs in group D(P>0.05).Conclusions The use of Dex cannot affect SEPs and TCeMEPs during idiopathic scoliosis osteotomy,but can reduce the doses of general anesthetics and decrease MAP to reduce intraoperative bleeding and facilitate the whole process.It also decreases heart rate to maintain hemodynamics stable,while reducing agitation during the recovery period.