CAJ | 학술논문

目的将肌松监测和脑电监测相结合,探索在部分神经肌肉阻滞及不同麻醉深度对经颅电刺激运动诱发电位(TceMEP)的影响.方法 12例行神经外科手术的患者术中行TceMEP监测,同时监测脑电图和5个成串刺激(TOF),计算爆发抑制比(BSR)和T4与T1比值,在BSR=0、肌松完全恢复后记录TceMEP基线;调节异丙酚和肌松药剂量,分别在肌松恢复、0.25＜BSR＜0.5和BSR＞0.75以及BSR=0、T4/T1为25%时记录TceMEP并评估刺激时患者出现体动的情况.结果基线时患者出现体动率较高(9/10),在肌松恢复、0.25＜BSR＜0.5和BSR＞0.75两种情况下体动发生率降低(1/10和0/10),TceMEP波幅较基线时下降明显(P＜0.05和P＜0.01);部分肌松且BSR=0时TceMEP波幅较基线时相差不多(P＞0.05),10例中仅1例出现体动;各种情况下的潜伏期比较差异无统计学意义.结论术中进行TceMEP监测,需避免盲目增加麻醉药物剂量加深麻醉;在脑电图未出现爆发-抑制波形时,使T4/T1维持在25%,可以有效记录TceMEP,又能降低患者发生体动的风险.
목적 장기송감측화뇌전감측상결합,탐색재부분신경기육조체급불동마취심도대경로전자격운동유발전위(TceMEP)적영향.방법 12례행신경외과수술적환자술중행TceMEP감측,동시감측뇌전도화5개성천자격(TOF),계산폭발억제비(BSR)화T4여T1비치,재BSR=0、기송완전회복후기록TceMEP기선;조절이병분화기송약제량,분별재기송회복、0.25＜BSR＜0.5화BSR＞0.75이급BSR=0、T4/T1위25%시기록TceMEP병평고자격시환자출현체동적정황.결과 기선시환자출현체동솔교고(9/10),재기송회복、0.25＜BSR＜0.5화BSR＞0.75량충정황하체동발생솔강저(1/10화0/10),TceMEP파폭교기선시하강명현(P＜0.05화P＜0.01);부분기송차BSR=0시TceMEP파폭교기선시상차불다(P＞0.05),10례중부1례출현체동;각충정황하적잠복기비교차이무통계학의의.결론 술중진행TceMEP감측,수피면맹목증가마취약물제량가심마취;재뇌전도미출현폭발-억제파형시,사T4/T1유지재25%,가이유효기록TceMEP,우능강저환자발생체동적풍험.
Objective To explore the influences of partial muscle relax and depth of anesthesia on transcranial electrical motor evoked potential (TceMEP).Methods 12 patients undergoing neurosurgical operation were enrolled.Anesthesia was maintained with sevoflurane , propofol and remifentanil.The level of muscle relax and anesthesia depth were monitored by train of five stimulation (TOF) and burst -suppressed rate (BSR).After the baseline recording when T4 equal tn T1 and there was no burst suppression wave on EEG( BSR =0), then BSR was increased to 0.25 ～0.5 and above 0.75 by regulating dosage of propofol and TceMEP was recorded respectively .At the state of disapperance of burst suppression wave and cisatracurium (40～ 80)μg/(kg/h) was administered simultaneously, when T4 / T1 was equal to 25% TceMEP was elicited again.The movements of patients were also assessed during monitoring.Results The incidence of patient's movement at baseline was high(9/10).At the state of recovery of muscle relax,movement incidence was decreased and the amplitude of TceMEP was attenuated greatly when 0.25 ＜ BSR ＜0.5 and BSR ＞0.75 comparing to baseline( ＜0.05 and ＜0.01 respectively).When BSR =0 and T4 /T1 was equal to 25% , a similar intensity stimulation could almost maintain the amplitude of TceMEP as well as baseline( P ＞0.05) ,but there was only 1 patient showing movement.The latency of TceMEPs was not significantly different comparing to baseline.Conclusions Monitoring of TceMEP need to avoid the presence of burst suppression waves EEG by deepening anaesthesia.TceMEP could be recorded at the state of partial muscle relax by T4 / T1 equal to 25% and without burst suppression wave EEG, in which the risk of movement of patients responsed to transcranial stimulation is decreased and the effect on TceMEP is reduced.