顺式阿曲库铵复合利多卡因全身麻醉诱导对运动诱发电位的影响

Effect of general anesthesia induction with different doses of cisatracurium combined with lidocaine on motorevoked potential

目的探讨在全身麻醉诱导期间使用不同剂量顺式阿曲库铵复合利多卡因对拟行颅内肿瘤切除术患者运动诱发电位(MEP)的影响。方法在MEP监测下行颅内肿瘤切除术的患者46例分为两组,每组23例。A组采用顺式阿曲库铵0.10 mg/kg复合利多卡因1 mg/kg诱导,B组采用顺式阿曲库铵0.15 mg/kg复合利多卡因1 mg/kg诱导。两组患者均在麻醉开始前使用脑电双频指数(BIS)监测麻醉深度。记录两组麻醉诱导前(T0)、气管插管后2 min(T1)、麻醉诱导后35 min(T2)和50 min(T3)时的HR、MAP和BIS,观察T2、T3时的MEP信号检出率、波幅和潜伏期。结果与T0时比较,两组T1~T3时的MAP、HR和BIS均降低(P<0.05);但两组间差异均无统计学意义(P>0.05)。A组T2时MEP信号检出率高于B组(P<0.05)。A组T2、T3时MEP波幅均高于B组(P<0.05),两组T3时MEP波幅均高于T2时(P<0.05)。与T2时比较,B组T3时MEP潜伏期缩短(P<0.05)。结论全身麻醉诱导中使用顺式阿曲库铵0.10 mg/kg复合利多卡因可以更早、更有效地监测到患者的MEP信号,减少术后神经系统并发症的发生,提高肿瘤的切除率。

Objective To investigate the effect of different doses of cisatracurium combined with lidocaine during general anesthesia induction on motor-evoked potential(MEP)in the patients undergoing intracranial tumor resection.Methods Intraoperative MEP monitoring was performed in 46 patients undergoing intracranial tumor resection.The patients were divided into two groups with 23 cases each.During general anesthesia induction,group A was given cisatracurium o.10 mg/kg combined with lidocaine 1 mg/kg,while group B was given cisatracurium 0.15 mg/kg combined with lidocaine 1 mg/kg.The anesthesia depth was monitored with bispectral index(BIS).The changes in HR,MAP and BIS of two groups before anesthesia induction(TO),2 minutes after tracheal intubation(T1),35 minutes after anesthesia induction(T2),and 50 minutes after anesthesia induction(T3)were recorded.The detection rate,amplitude and latency of MEP signals at T2 and T3 of two groups were observed.Results Compared with TO,the MAP,HR and BIS at T1 to T3 were decreased in the two groups(P<0.05),which were not significantly different between the two groups(P>0.05).At T2,the detection rate of MEP signal in group A was higher than that in group B(P<0.05).At T2 and T3,the amplitude of MEP in group A was higher than that in group B(P<0.05).Compared with T2,the amplitude of MEP was increased at T3 in the two groups(P<0.05).Compared with T2,the MEP latency in group B was shorter at T3(P<0.05).Conclusion In the patients undergoing intracranial tumor resection,the use of cisatracurium O.10 mg/kg combined with lidocaine in the induction of general anesthesia can monitor the MEP signal earlier and more effectively,reduce the occurrence of postoperative neurological complications,and improve the resection rate of tumors.