异丙酚对脊柱手术患者经颅电刺激运动诱发电位振幅影响及机制探讨

Effect of Propofol on Amplitude of Transcranial Electrical Stimulation Motor Evoked Potential in Patients Undergoing Spinal Surgery and Its Mechanism

目的 通过全麻下的诱发肌电图(H-反射波、M-波和F-波),评估异丙酚对经颅电刺激运动诱发电位(TCE-MEP)振幅的影响及机制。方法 研究对象为30例在全身麻醉下进行脊柱手术的患者。使用靶控输注,在三种异丙酚浓度(2.0、3.0和4.0 mg/L)下测量比目鱼肌诱发肌电图,以及拇短展肌、股四头肌、胫骨前肌、展肌、比目鱼肌和腘绳肌的TCE-MEP。结果 随着异丙酚剂量增加,患者比目鱼肌右侧M-波振幅增加(所有P<0.05)。随着异丙酚剂量增加,患者拇短展肌、股四头肌、胫骨前肌、拇展肌、比目鱼肌和腘绳肌的TCE-MEP振幅均降低(所有P<0.05)。观察期间患者未发生不良事件。结论 异丙酚不会影响H-反射波和F-波振幅,而TCE-MEP振幅在较高异丙酚浓度下降低,说明异丙酚可能通过抑制脊髓上运动通路,从而抑制TCE-MEP振幅。

Objective The effect and mechanism of the effect of propofol on the amplitude of transcranial electrical stimulation motor evoked potential(TCE-MEP)was evaluated by evoked electromyography(H-reflex,M-wave and F-wave)under general anesthesia.Methods The subjects were 30 patients undergoing spinal surgery under general anesthesia.Using target-controlled infusion,the soleus muscle evoked electromyography and TCE-MEP of abductor pollicis brevis,quadriceps femoris,anterior tibial muscle,abductor pollicis,soleus muscle and hamstring muscle were measured at three concentrations of propofol(2.0,3.0 and 4.0μg/mL).Results With the increase of propofol dose,the amplitude of M-wave on the right side of patients increased(all P<0.05).With the increase of propofol dose,the TCE-MEP amplitude of different muscles in patients decreased(all P<0.05).No adverse events occurred during the observation period.Conclusion Propofol did not affect the amplitudes of the H-refex and the F-wave,whereas TCE-MEP amplitudes were reduced at higher propofol concentrations.These results suggested that propofol can suppress the TCE-MEP amplitude by inhibiting the supraspinal motor pathways more strongly than the excitability of the motor neurons in the spinal cord.