CAJ | 학술논문

目的通过对相关麻醉监测指标与运动诱发电位(MEP)相互关系的分析,探讨全身麻醉下更可靠地评价MEP监测指标的方法.方法　选取2001年2月至2004年6月26例接受脊柱脊髓手术的患者,术中使用依托咪酯和芬太尼进行麻醉,应用双频指数(BIS)和四个成串刺激(TOF)监测麻醉深度与肌松状态,使用经颅磁刺激运动诱发电位(TMS-MEP)进行术中监测.记录不同麻醉深度与肌松状态下的TMS-MEP,分析MEP随着麻醉深度与肌松状态而变化的规律,并尝试利用这一规律来分析术中MEP变化的原因.结果所有病例麻醉状态下MEP的波幅均与相应时间的BIS和TOF监测指标呈正相关,多元回归分析可以在这些指标间建立有效的回归方程(F=15.274～152.513,P＜0.01).当麻醉深度与肌松状态发生变化时,将对应的BIS和T1/T.输入该回归方程,可以对MEP的波幅进行有效地预测.在手术操作导致MEP波幅降低的情况下,MEP波幅的实测值会显著偏离预测值,从而有利于区分MEP变化的真实原因是手术操作,还是麻醉深度与肌松状态的改变.不同患者回归方程的截距与偏回归系数各不相同,丑差异较大,回归方程在不同患者之间不能相互替代.结论　将麻醉与肌松的监测指标BIS、T1/T.以及相应的同归方程纳入MEP术中监测结果的分析,是一个非常实用而且有效的方法,可用以排除麻醉状态的波动对MEP变化原因判断的干扰.
목적 통과대상관마취감측지표여운동유발전위(MEP)상호관계적분석,탐토전신마취하경가고지평개MEP감측지표적방법.방법　선취2001년2월지2004년6월26례접수척주척수수술적환자,술중사용의탁미지화분태니진행마취,응용쌍빈지수(BIS)화사개성천자격(TOF)감측마취심도여기송상태,사용경로자자격운동유발전위(TMS-MEP)진행술중감측.기록불동마취심도여기송상태하적TMS-MEP,분석MEP수착마취심도여기송상태이변화적규률,병상시이용저일규률래분석술중MEP변화적원인.결과 소유병례마취상태하MEP적파폭균여상응시간적BIS화TOF감측지표정정상관,다원회귀분석가이재저사지표간건립유효적회귀방정(F=15.274～152.513,P＜0.01).당마취심도여기송상태발생변화시,장대응적BIS화T1/T.수입해회귀방정,가이대MEP적파폭진행유효지예측.재수술조작도치MEP파폭강저적정황하,MEP파폭적실측치회현저편리예측치,종이유리우구분MEP변화적진실원인시수술조작,환시마취심도여기송상태적개변.불동환자회귀방정적절거여편회귀계수각불상동,축차이교대,회귀방정재불동환자지간불능상호체대.결론　장마취여기송적감측지표BIS、T1/T.이급상응적동귀방정납입MEP술중감측결과적분석,시일개비상실용이차유효적방법,가용이배제마취상태적파동대MEP변화원인판단적간우.
Objective To find a way to discriminate operative reason from anaesthesia reason for the changes of intraoperative transcranial magnetic motor evoked potentials (MEPs). Methods In 26 patients under Etomidate/Fentanyl anesthesia from Feburary 2001 to June 2004,MEPs elicited by transcranial magnetie stimulation were recorded from tibialis anterior muscles,simultaneously bispectral index (BIS) and train-of-four stimulation (TOF) were used to monitor the anesthesia depth and neuromuscular blockade respectively.MEP,BIS and measurements of TOF at different anesthesia depth and muscular relaxation were recorded synchronously,statistical analysis of this data set was done in order to find the inherent relationship between these variables.Results Under anesthesia.MEP amplitude was always positively correlated with the corresponding BIS and TOF value.A regression equation could be built,with which the MEP amplitude could be reckoned based on realtime BIS and T1/T.In ease of spinal cord injury,the measured amplitude value would signifieantly deviate from predicted one,which suggested that the change of MEP was because of the operation,but not the anaesthesia or nenromuscular blockade. Each patient had his or her own regression equation,which was different from eaeh other. Conclusions The establishment of regression equation from MEPs,BIS and TOF is very useful to distinguish reasons of the changes of transcranial magnetic MEPs during surgery,and with this technique,the intraoperative MEP monitoring should be more reliable and practicable.