不同深度麻醉对甲状腺手术中喉返神经监测的影响

Effect of Different Depth Anesthesia on Monitoring of Recurrent Laryngeal Nerve During Thyroid Surgery

目的 探讨不同深度麻醉对甲状腺手术中喉返神经监测的影响。方法 选择南方医科大学深圳医院2019年7月-2020年12月收治的60例行甲状腺手术治疗的患者,将其随机分为2组,麻醉中予以脑电双频指数(bispectral index, BIS)监测,观察组患者术中BIS维持在55~65,对照组患者术中BIS维持在35~45。对比两组是否成功诱发肌电电位,初次刺激喉返神经时平均动脉压水平、七氟烷浓度,术后拔管时间。观察是否有术中体动,术中知晓等不良反应。结果 观察组和对照组均成功诱发肌电电位,初次刺激喉返神经时观察组血压更加平稳(P <0.05),观察组七氟烷用量更少(P <0.05),两组术后拔管时间没有显著差异(P>0.05),两组均未发生体动、术中知晓。结论 在BIS监测下,不同深度的麻醉均成功诱发肌电电位,为外科医生避开喉返神经提供参考。维持较高的BIS值,术中血压更加平稳,而不会发生体动,术中知晓等不良反应。

Objective To investigate the effect of different depth anesthesia on monitoring the recurrent laryngeal nerve during thyroid surgery. Methods Sixty patients who underwent thyroid surgery in our hospital from July 2019 to December 2020 were randomly divided into two groups.During anesthesia, BIS was monitored. The intraoperative BIS of the observation group was maintained at 55-65, while that of the control group was maintained at 35-45.The two groups were compared to see whether the electromyographic potential was successfully evoked, the mean arterial pressure level during the initial stimulation of recurrent laryngeal nerve, the concentration of sevoflurane, and the postoperative extubation time. observe whether there is intraoperative body movement, intraoperative awareness and other adverse reactions. Results EMG was successfully evoked in both the observation group and the control group, and the blood pressure of the observation group was more stable when the recurrent laryngeal nerve was stimulated for the first time(P <0.05), the amount of sevoflurane in the observation group was less(P <0.05), there was no significant difference in the time of extubation between the two groups(P >0.05), no body movement and intraoperative awareness occurred in both groups. Conclusion Under BIS monitoring, electromyographic potentials were successfully induced under different depths of anesthesia, which provides a reference for surgeons to avoid the recurrent laryngeal nerve.Maintaining a higher BIS value will result in more stable intraoperative blood pressure without any adverse reactions such as body movement and intraoperative awareness.