右美托咪定对脊柱侧弯手术患者体感诱发电位和运动诱发电位的影响

Effects of dexmedetomidine on somatosensory evoked potential and motor evoked potential in patients undergoing scoliosis surgery

目的评估不同剂量右美托咪定对脊柱侧弯手术患者体感诱发电位(SEP)和运动诱发电位(MEP)的影响。方法选取2019年1月至2023年3月在北京大望路急诊抢救医院治疗的60例脊柱侧弯手术患者作为研究对象。采用随机数字表法将患者分为对照组、低剂量右美托咪定组和高剂量右美托咪定组,每组20例。麻醉诱导后采用神经电生理监测系统监测T1(麻醉诱导后和右美托咪定输注前)、T2(右美托咪定给药后10 min)、T3(右美托咪定给药后20 min)、T4(右美托咪定给药后30 min)时SEP潜伏期和振幅,并评估SEP和MEP假阳性发生率。结果3组患者T1、T2、T3和T4时双下肢SEP潜伏期和振幅比较,差异无统计学意义(P>0.05)。3组患者SEP假阳性率比较无统计学差异(P>0.05)。对照组、低剂量组和高剂量组MEP假阳性率分别为5.0%、10.0%和40.0%,差异有统计学意义(X^(2)=11.832,P=0.012)。高剂量组和对照组高血压发病率差异有统计学意义(35.0%vs.5.0%,P=0.015)。结论右美托咪定对脊柱侧弯手术期间SEP监测没有影响,高剂量右美托咪定可能增加MEP信号假阳性率和术中高血压发生率。

Objective To evaluate the effects of different doses of dexmedetomidine on somatosensory evoked potential(SEP)and motor evoked potential(MEP)in patients undergoing scoliosis surgery.Methods Sixty patients with scoliosis treated in Beijing Dawanglu Emergency Rescue Hospital from January 2019 to March 2023 were enrolled as the research objects.The patients were divided into control group,low-dose dexmedetomidine group and high-dose dexmedetomidine group by random number table,with 20 cases in each group.After anesthesia induction,the latency and amplitude of SEP were monitored by neurophysiological monitoring system at T1(after anesthesia induction and before dexmedetomidine infusion),T2(10 min after dexmedetomidine administration),T3(20 minutes after dexmedetomidine administration)and T4(30 minutes after dexmedetomidine administration).The incidence of false positives of SEP and MEP was evaluated.Results The latency and amplitude of SEP in the lower limbs at T1,T2,T3 and T4 among 3 groups showed no statistical difference(P>0.05).There was no significant difference in the false positive rate of SEP among 3 groups(P>0.05).The false positive rates of MEP in control group,low-dose group and high-dose group were 5.0%,10.0%and 40.0%respectively,with statistically significant(X^(2)=11.832,P=0.012).There was a statistical difference in the incidence rate of hypertension between the high-dose group and the control group(35.0%vs.5.0%,P=0.015).Conclusion Dexmetomidine has no effects on SEP during scoliosis surgery,while high-dose dexmetomidine may increase the false positive rate of MEP and the incidence of intraoperative hypertension.