肌松药对面肌痉挛微血管减压术中电生理监测的影响

目的 探讨肌松药对面肌痉挛（HFS）患者微血管减压术（MVD）术中侧方扩散波（LSR）监测的影响。方法 将2014年1月至2014年12月进行MVD术中LSR监测的206例HFS病人，依据肌松药使用不同随机分为罗库溴铵（ROC）组（76例）、顺苯磺酸阿曲库铵（CIS）组（69例）和对照组（不使用肌松药，61例），对比分析3组病人LSR诱导成功率、出现时间和波幅大小。结果 硬脑膜打开前，对照组LSR诱导成功率为100%，明显高于ROC组（75%；P<0.01）和cis组（56.5%；>P<0.01），而且，后两组间也存在显著差异（>P<0.05）。对照组lsr平均出现时间（3.2±2.5）min]显著短于roc组（46.4±20.2）min，>P<0.01]和cis组（60.9±25.5）min，>P<0.01]。对照组lsr波幅亦明显高于roc组（>P<0.05）和cis组（>P<0.05）。此外，与cis组相比，roc组lsr出现时间更短（>P<0.05），且呈线性关系lsr出现时间>P<0.05]。>结论 使用肌松药可导致LSR诱导成功率降低、延迟出现和波幅减小，因此，建议在MVD术中行LSR监测时尽量不使用肌松药或仅小剂量（≤0.6mg/kg）使用ROC。

Effect of muscle relaxants on lateral spread responses during microvascular decompression for hemifacial spasm

Objective To investigate the effect of muscle relaxants on later spread response (LSR) monitored by electrophysiological technique in microvascular decompression (MVD) for hemifacial spasm (HFS). Methods From January to December 2014, of 206 patients with HFS, who were treated by MVD during which neurophysiological monitoring was performed, 76 received rocuronium (ROC) treatment during anesthesia for endotracheal intubation (ROC group), 69 cisacurium (CIS) (CIS group) and 61 patients did not receive muscle relaxants treatment blank control (BC) group]. LSR occurrence rate, induction time and amplitude size were compared among the three groups. Result Before opening dura mater, the LSR occurrence rate in BC group (100%) was significantly higher than those in ROC group (75.0%, 57/76; PP<0.01). there="" was="" significant="" difference="" in="" lsr="" occurrence="" rates="" between="" both="" roc="" and="" cis="" groups="" (P<0.05). the="" lsr="" induction="" time="" (3.2±2.5)min]="" was="" significantly="" shorter="" in="" bc="" group="" than="" that="" (46.4±20.2)min]="" roc="" (P<0.01), which="" was="" significantly="" shorter="" than="" that="" (60.9±25.5)min]="" in="" cis="" group="" (P<0.01). lsr="" amplitude="" size="" was="" significantly="" higher="" in="" bc="" group="" than="" those="" both="" roc="" and="" cis="" groups="" (P<0.05). lsr="" induction="" time="" was="" positively="" related="" to="" the="" dose="" of="" roc="" in="" group="" (P