术中无肌松全静脉麻醉用于联合神经电生理监护脊柱手术的可行性

［摘要］ 目的 比较全静脉麻醉下术中使用或不使用肌松药对脊柱手术中联合神经电生理监测结果的影响，探讨安全有效的神经电生理监测麻醉方案。方法 选择拟行联合神经电生理监测的择期脊柱手术病人 40 例，分为A、B两组。两组病人均采用丙泊酚、瑞芬太尼和右美托咪定全凭静脉麻醉，A组病人术中使用小剂量阿曲库铵维持肌松，B组病人术中不使用肌松药。同时监测体感诱发电位（SEP）和运动诱发电位（MEP）评判脊髓功能。记录术中不同时间点两组病人的生命体征和SEP和MEP的波幅和潜伏期，同时记录经颅电刺激时病人是否出现剧烈体动和自主呼吸。比较两组病人术毕后麻醉苏醒时间和质量。结果 两组病人不同时间点的生命体征差异无统计学意义。两组病人的SEP的波幅和潜伏期差异无统计学意义，MEP的潜伏期差异无统计学意义，MEP的波幅差异有显著性统计学意义。两组病人在电刺激时均无自主呼吸和剧烈体动发生。结论 术中不使用肌松药的全静脉麻醉方案可安全有效地用于行神经电生理监测的脊柱手术，并且在电生理监测信号质量和术后苏醒方面具有明显优势。

Feasibility of total intravenous anesthesia without muscle relaxants in spinal surgery with combined electroneurophilogy monitoring

［Abstract］ Objective To compare the effects of total intravenous anesthesia with or without muscle relaxants on combined electroneurophilogy monitoring of the spinal cord during the spinal surgery， and to explore a safe and effective anesthesia protocol for electroneurophilogy monitoring. Methods Forty patients undergoing selective spinal surgery who underwent combined electroneurophilogy monitoring were enrolled and divided into A and B groups. All patients were anesthetized by propofol， remifentanil and dexmedetomidine. Patients in group A were treated with small doses of atracurium to maintain muscle relaxation during the surgery， while patients in group B were treated without muscle relaxants. Combined electroneurophilogy monitoring， somatosensory evoked potentials （SEP） and motor evoked potentials （MEP）， were used to monitor the spinal cord function. The amplitudes and latencies of SEP and MEP were recorded at different time points during the operation， and the occurrence of severe body motility and spontaneous breathing during transcranial electrical stimulation was also recorded. The recovery time and quality of anesthesia after operation were compared between the two groups. Results There was no significant difference in the amplitude and latency of SEP between the two groups at different time points. The latencies of MEP were similar （P>0.05）， while the amplitudes of MEP had significant difference between two groups （P<0.05）. No spontaneous breathing and severe body motility was detected during the surgery. The recovery time in group B is significantly shorter than that in group A （P<0.01）. Conclusion Our protocol of total intravenous anesthesia （propofol， remifentanil and dexmedetomidine） without muscle relaxants can be safely and effectively applied in spinal surgery with combined electroneurophilogy monitoring， and has obvious advantages in signal quality and postoperative recovery.