顺式阿曲库铵部分肌松对全麻术中面神经监测的可行性评价

目的: 探讨在需要监测面神经的颅颌面手术中,使用非去极化肌松药顺式阿曲库铵部分肌松状态下进行面神经监测的可行性,并确定其合适的肌松程度。方法: 选择107例术前面神经功能正常、需行颅颌面择期手术及面神经监测的患者,术中使用异丙酚、咪唑安定、瑞芬太尼、顺式阿曲库铵实施全凭静脉麻醉（TIVA）维持全麻,术中由外科医师分别在TOF%（T4/T1）及T1%（T1/T0） 处于不同肌松区间时刺激面神经,记录不同肌松程度下面神经肌电图（EMG）的反应及数值,同时记录术中患者体动评分及是否存在呼吸机对抗。采用SPSS 26.0软件包,绘制受试者工作特征曲线（ROC）,确定面神经监测最佳肌松临床界值; χ²检验分析体动评分及麻醉机对抗与不同肌松程度的关系。结果: 面神经监测有效的最佳肌松临床界值TOF%为15%,T1%为35%,T1%优于TOF%;TOF%>50%、T1%>60%时,患者在术中可能出现体动,呼吸机对抗增加。结论: 全麻使用顺式阿曲库铵部分肌松状态下可有效进行面神经监测,适合的肌松范围推荐TOF%为15%~50%,T1%为35%~60%。

The feasibility of facial nerve monitoring during general anesthesia with partial muscular relaxation of cis-atracurium

PURPOSE: To explore the feasibility of facial nerve monitoring when using non-depolarizing muscle relaxant cis-atracurium in craniomaxillofacial surgery, and to determine the appropriate degree of muscular relaxation. METHODS: A total of 107 patients with normal preoperative facial nerve function who were planned to undergo elective craniomaxillofacial surgery and needed facial nerve monitoring during operation were selected. Propofol, midazolam, remifentanil and cis-atracurium were used to maintain general anesthesia by total intravenous anesthesia (TIVA). During operation, the surgeons stimulated the facial nerve when TOF%(T4/T1) and T1%(T1/T0) were in different muscular relaxation ranges, while the response and the value of electromyography(EMG) were recorded under different degrees of muscular relaxation. At the same time, the patient's body movement score and the presence of ventilator confrontation were recorded. SPSS 26.0 software package was used to draw the receiver operating characteristic curve (ROC), to determine the best cutoff points for neuromuscular blockade. The relationship between body movement score,ventilation confrontation and different degrees of neuromuscular blockade was analyzed by chi square test. RESULTS: The best cutoff points of TOF% and T1% were obtained: TOF% was 15%, T1% was 35%,and T1% was better than TOF%; when TOF%> 50% and T1%>60%, the patient might have body movement, and the ventilator confrontation increased during operation（P<0.05）. CONCLUSIONS: Facial nerve monitoring can be effectively performed under partial neuromuscular blockade of cis-atracurium in general anesthesia. The recommended range of muscle relaxation is 15%-50% for TOF% and 35%-60% for T1%.