摘要
目的探讨顺式阿曲库铵对颅内肿瘤切除术病人运动诱发电位(MEP)的影响。方法选取2016年1月至2018年9月择期行MEP监测下手术治疗的120例颅内肿瘤为研究对象,根据顺式阿曲库铵使用方法分为A、B、C三组,各40例。麻醉诱导期时均给予咪达唑仑(0.07 mg/kg)+丙泊酚(2 mg/kg)+舒芬太尼(0.4μg/kg)+顺式阿曲库铵(0.15 mg/kg)。麻醉维持期:A组给予顺式阿曲库铵,剂量为0.5μg/(kg·min);B组给予顺式阿曲库铵,剂量为0.7μg/(kg·min);C组不给予肌松药。结果与C组比较,A组和B组病灶切除时、手术结束时心率和平均动脉压均明显增高(P<0.05),术中丙泊酚用量明显减少(P<0.05),低血压和体动反应发生率明显降低(P<0.05),自主呼吸恢复时间、苏醒时间和拔管时间明显延长(P<0.05);A组和B组均无统计学差异(P>0.05)。与C组比较,A组和B组在切开硬脑膜后即刻、切开硬脑膜后1 h、病灶切除后即刻MEP波幅明显降低(P<0.05),并且B组明显低于A组(P<0.05);B组在切开硬脑膜后即刻、切开硬脑膜后1 h、病灶切除后即刻MEP潜伏期明显缩短(P<0.05),但是A、C组之间以及A、B组之间均无统计学差异(P>0.05)。结论颅内肿瘤切除术病人麻醉诱导期给予0.15 mg/kg顺式阿曲库铵,随后用0.5μg/(kg·min)维持,对MEP影响较小,并且可维持血流动力学稳定,减少术中体动反应。
Objective To investigate the effect of cisatracurium on the motor evoked potential(MEP)in the patients undergoing intracranial tumor resection.Methods A total of 120 patients with intracranial tumors who underwent elective surgical treatment under MEP monitoring from January 2016 to September 2018 were reruited in this study.According to the usage of cis-atracurium,these 120 patients were divided into three groups,i.e.,group A,group B,and group C,with 40 patients each.Midazolam(0.07 mg/kg)+propofol(2 mg/kg)+sufentanil(0.4μg/kg)+cis-atracurium(0.15 mg/kg)were used during the induction period of anesthesia.During anesthesia maintenance period:group A received cis-atracurium at a dose of 0.5μg/(kg·min);group B received cis-atracurium at a dose of 0.7μg/(kg·min);group C did not receive muscle relaxants.Results The heart rate and mean arterial pressure were significantly increased at the time of tumor resection and at the end of the operation(P<0.05),the intraoperative propofol dosage was significantly reduced(P<0.05),the incidence of hypotension and body kinesis was significantly reduced(P<0.05),and the recovery time of spontaneous breathing,recovery time and extubation time were significantly prolonged(P<0.05)in groups A and B compared with group C,but there was no statistical difference between group A and group B(P>0.05).The MEP amplitudes were significantly reduced immediately after dura mater incision,1 hour after dura mater incision,and immediately after lesion resection in groups B than group A,which were were significantly reduced compared with group C(P<0.05).The incubation period of MEP was significantly shortened immediately after dura mater incision,1 hour after dura mater incision,and immediately after tumor resection in group B than thoses in groups A and C(P<0.05),but there was no statistical difference between groups A and C(P>0.05).Conclusion For patients with intracranial tumor,use of 0.15 mg/kg cis-atracurium during the induction of anesthesia,followed by 0.5μg/(kg·min)maintenance,has little effect on MEP,and can maintain hemodynamic stability and reduce intraoperative body movement response.
作者
聂金凤
伍谷
刘强
陈榔波
NIE Jin-feng;WU Gu;LIU Qiang;CHEN Lang-bo(Department of Anesthesiology,First People's Hospital of Chongqing Liangjiang New Area,Chongqing 401147,China;Department of Neurosurgery,First People's Hospital of Chongqing Liangjiang New Area,Chongqing 401147,China)
出处
《中国临床神经外科杂志》
2020年第8期506-509,共4页
Chinese Journal of Clinical Neurosurgery
