经颅电刺激运动诱发电位监测麻醉方法的建立

目的 对比相同麻醉深度下丙泊酚、七氟醚分别复合瑞芬太尼维持麻醉对经颅电刺激运动诱发电位(TES-MEPs)波幅和潜伏期的影响,以建立术中MEP监测时的适宜麻醉方法.方法 36例脊髓脊柱神经外科手术患者随机分为两组:丙泊酚麻醉组和七氟醚麻醉组,每组18例.对比麻醉诱导后30 min、60 min、90 min和120 min MEP的波幅和潜伏期.结果 两组病例麻醉期间血流动力学均维持稳定,组间脑电双频指数、呼气末二氧化碳分压和体温的差异均无统计学意义.丙泊酚组MEP所需阈刺激强度显著低于七氟醚组(172±23)V:(217±42)V,P＜0.05].丙泊酚组各时间点上肢MEP波幅显著高于七氟醚组(P＜0.05),潜伏期显著短于七氟醚组(P＜0.05).两组内各时间点上肢MEP波幅和潜伏期差异无统计学意义.结论 在相同麻醉深度下,丙泊酚复合瑞芬太尼全凭静脉麻醉对MEP波幅的抑制作用显著优于七氟醚复合瑞芬太尼静吸复合麻醉方案,是用于脊髓脊柱手术TES-MEPs监测的适宜麻醉方法.

Establishment of anesthesia regimen for transcranial electrical motor evoked potentials monitoring in spine surgery

Objective To compare the effects of propofol (PR) and sevoflurane (SR) combind with remifentanil on amplitudes and latency of TES-MEPs under equivalent anesthesia depth and to investigate optimal anesthesia regimen for TES-MEPs.Methods 36 patients undergoing spinal surgery were randomly divided into two groups: group PR (n=18) and group SR (n =18).After TES-MEPs monitoring system was established,the amplitudes and latencies of TES-MEPs at 30 min,60 min,90 min and 120 min after induced anesthesia were compared.Results There was no apparent fluctuation of heamodynamics and no significant difference in BIS,PEr CO2,and body temperature between the two groups.The minimal essential stimulus intensity in group PR was significant lower than that in group SR(172±23) V: (217 ±42) V,P＜0.05].The amplitude of upper limb TES-MEPs in group PR was significant higher than that in group SR (P＜0.05),but the latency in group PR was significant shorter than that in group SR(P＜0.05).There was no significant difference in amplitude and latency at all time points in each group groups (P＞0.05).Conclusion Under equivalent anesthesia depth,the inhibition effects of propofol (3～4 μg/ml) with remifentanil (4 ng/ml) on amplitudes and latencies of TES-MEPs are Less significant than these of sevoflurane(0.7～0.8 MAC) with remifentanil(4 ng/ml).So propofol (3～4 μg/ml) with remifentanil (4ng/ml) is more compatible for TES-MEPs monitoring in spinal neurosurgery.