摘要
目的评价不同剂量顺式阿曲库铵对颅内动脉瘤夹闭术患者运动诱发电位(MEP)监测的影响。方法择期全麻下行颅内动脉瘤夹闭术患者80例,性别不限,年龄18~64岁,体重指数<30 kg/,ASA分级Ⅰ或Ⅱ级,Hunt-Hess分级0-Ⅱ级。采用随机数字表法分为4组(n=20):常规组(R组)和不同剂量顺式阿曲库铵组(Cis1-3组)。麻醉诱导后行肌松监测,采用四个成串刺激(TOF)模式(频率2 Hz,波宽0.2 ms,串间间隔15 s)刺激前臂尺神经,记录TOF比值作为基础值(T1)。麻醉诱导后采用神经电生理监测仪监测MEP。TOF比值恢复至基础值且MEP可有效引出时,Cis1-3组分别静脉输注顺式阿曲库铵0.625、0.833、1.000 μg·kg-1·min-1,R组静脉输注等容量生理盐水。分别于T1、剪开硬脑膜即刻(T2)、夹闭动脉瘤即刻(T3)和缝合硬脑膜结束即刻(T4)记录TOF比值;记录术中MEP有效引出情况;记录术中心血管事件、自主呼吸恢复及体动等发生情况。结果与R组比较,Cis1组各时点TOF比值差异无统计学意义(P>0.05),Cis2组T2-4时TOF比值降低,Cis3组T2-4时TOF比值降低(P<0.05);与Cis1组比较,Cis2组T3,4时TOF比值降低,Cis3组T2-4时TOF比值降低(P<0.05)。4组MEP有效引出率均为100%。4组术中心血管事件、自主呼吸恢复及体动发生率比较差异无统计学意义(P>0.05)。结论静脉输注顺式阿曲库铵0.833~1.000 μg·kg-1·min-1用于颅内动脉瘤夹闭术患者可维持一定肌松程度,又不会对MEP监测产生影响。
Objective To evaluate the effect of different doses of cisatracurium on the monitoring of motor-evoked potentials(MEPs)in the patients undergoing intracranial aneurysm clipping.Methods Eighty patients of both sexes,aged 18-64 yr,with body mass index<30 kg/m2,of American Society of Anesthesiologists physical statusⅠorⅡ,with Hunt-Hess grade 0-Ⅱ,undergoing intracranial aneurysm clipping under general anesthesia,were divided into 4 groups(n=20 each)using a random number table method:conventional group(group R)and different doses of cis-atracurium groups(Cis1-3 groups).After anesthesia induction,muscle relaxation was monitored,and train-of-four(TOF)stimulation(frequency 2 Hz,wave width 0.2 ms,interval 15 s)was applied to the ulnar nerve of forearm,and the TOF ratio was recorded as the baseline value(T1).MEPs were assessed with a nerve electrophysiology monitor after induction of anesthesia.In Cis1-3 groups,cis-atracurium 0.625,0.833 and 1.000μg·kg-1·min-1 were intravenously infused,while the equal volume of normal saline was given instead in group R when TOF ratio returned to the baseline value and MEPs could be effectively elicited.At T1,immediately after dural incision(T2),immediately after aneurysm occlusion(T3)and immediately after dural closure(T4),the TOF ratio,effective elicitation of intraoperative MEPs,and occurrence of intraoperative cardiovascular events,recovery of spontaneous breathing and body movement were recorded.Results Compared with group R,no significant change was found in TOF ratio at each time point in group Cis1(P>0.05),and TOF ratio was significantly decreased at T2-4 in group Cis2 and at T2-4 in group Cis3(P<0.05).Compared with group Cis1,TOF ratio was significantly decreased at T3,4 in group Cis2 and at T2-4 in group Cis3(P<0.05).The effective elicitation rate of MEPs was 100%in the four groups.There was no significant difference in the incidence of intraoperative cardiovascular events,recovery of spontaneous breathing and body movement among the four groups(P>0.05).Conclusion Continuous intravenous infusion of cis-atracurium 0.833-1.000μg·kg-1·min-1 can maintain a certain degree of muscle relaxation without affecting MEP monitoring in the patients undergoing intracranial aneurysm clipping.
作者
曹静
梁治
刘进德
高璐超
步雪静
康静超
赵月
徐雪
Cao Jing;Liang Zhi;Liu Jinde;Gao Luchao;Bu Xuejing;Kang Jingchao;Zhao Yue;Xu Xue(Department of Anesthesiology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Anesthesiology,General Hospital of Huabei Petroleum Administration Bureau,Renqiu 062552,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2020年第2期213-216,共4页
Chinese Journal of Anesthesiology
关键词
阿曲库铵
诱发电位
运动
颅内动脉瘤
Atracurium
Evoked potentials
motor
Intracranial aneurysm
