CAJ | 학술논문

目的探讨罗库溴铵不同神经肌肉阻滞(NMB)程度对听神经瘤切除术患者面神经诱发肌电图(EEMG)监测的影响.方法择期在全身麻醉下行听神经瘤切除术患者35例,年龄20～64岁,性别不限,体重指数≤30 kg/m2,ASA分级Ⅰ或Ⅱ级.采用美国Axon公司的Epoch XP2000型16通道多功能电生理监测仪监测面神经EEMG,术中电刺激面神经,记录眼轮匝肌的诱发电位；采用荷兰0rganon公司的TOF-Watch SX肌松监测仪监测外周NMB程度,采用四个成串刺激模式.静脉注射罗库溴铵0.6 mg/kg后,在不同外周NMB程度(100％、75％、50％、25％、0)时测定面神经EEMG的振幅和潜伏期,计算振幅保留比率(实测EEMG振幅与基础值的比值).面神经EEMG的振幅保留比率与外周NMB程度间进行直线回归分析,面神经EEMG的振幅保留比率和潜伏期分别与外周NMB程度间进行等级相关分析.结果当NMB为100％,有6例患者未能诱发出EEMG反应；振幅保留比率(Y)与外周NMB(X)程度之间的回归方程为Y=1-0.787X,决定系数为0.898(P＜ 0.05);二者间的相关系数为-0.947(P ＜0.05)；潜伏期与外周NMB间的相关系数为0.328(P＜ 0.05).结论听神经瘤切除术中维持外周NMB 25％～50％时不仅可保证有效地监测面神经EEMG,而且具有良好的制动效果.
목적 탐토라고추안불동신경기육조체(NMB)정도대은신경류절제술환자면신경유발기전도(EEMG)감측적영향.방법 택기재전신마취하행은신경류절제술환자35례,년령20～64세,성별불한,체중지수≤30 kg/m2,ASA분급Ⅰ혹Ⅱ급.채용미국Axon공사적Epoch XP2000형16통도다공능전생리감측의감측면신경EEMG,술중전자격면신경,기록안륜잡기적유발전위；채용하란0rganon공사적TOF-Watch SX기송감측의감측외주NMB정도,채용사개성천자격모식.정맥주사라고추안0.6 mg/kg후,재불동외주NMB정도(100％、75％、50％、25％、0)시측정면신경EEMG적진폭화잠복기,계산진폭보류비솔(실측EEMG진폭여기출치적비치).면신경EEMG적진폭보류비솔여외주NMB정도간진행직선회귀분석,면신경EEMG적진폭보류비솔화잠복기분별여외주NMB정도간진행등급상관분석.결과 당NMB위100％,유6례환자미능유발출EEMG반응；진폭보류비솔(Y)여외주NMB(X)정도지간적회귀방정위Y=1-0.787X,결정계수위0.898(P＜ 0.05);이자간적상관계수위-0.947(P ＜0.05)；잠복기여외주NMB간적상관계수위0.328(P＜ 0.05).결론 은신경류절제술중유지외주NMB 25％～50％시불부가보증유효지감측면신경EEMG,이차구유량호적제동효과.
Objective To investigate the effects of different degrees of neuromuscular blockade (NMB) induced by rocuronium on facial nerve evoked-electromyographic (EEMG) monitoring in patients undergoing resection of acoustic neuroma.Methods Thirty-five ASA Ⅰ or Ⅱ patients of both sexes,aged 20-64 yr,with body mass index ≤30 kg/m2,scheduled for elective resection of acoustic neuroma under general anesthesia,were included in the study.Anesthesia was induced with midazolam,fentanyl and propofol.The patients were mechanically ventilated after tracheal intubation.Facial nerve EEMG monitoring and peripheral NMB monitoring were performed simultaneously during operation.Facial nerve EEMG was monitored using the Epoch XP2000 multichannel electrophysiological nerve monitoring system (Axon Co.,USA),facial nerve was stimulated and evoked potential of orbicularis oculi was recorded during operation.Peripheral NMB degrees were monitored with TOF-Watch SX monitor (Organon Co.Holland).After rocuronium 0.6 mg/kg was injected intravenously,the facial nerve EEMG responses were monitored when the degree of NMB (T1) was at 100％,75％,50％,25％ and 0 of the control height.The amplitude and latency of EEMG were recorded.The amplitude reservation ratio (the ratio of the amplitude of EEMG monitored to the baseline value) was calculated.Linear correlation of the amplitude reservation ratio or latency of EEMG with the degree of NMB was analyzed.Results No EEMG response was elicited when the degree of NMB was 100％ in 6 patients.The lirear regression equation of the interaction between the degree of NMB (X) and the amplitude reservation ratio (Y) was Y =1 - 0.787 X,the coefficient of determination was 0.898 ( P ＜ 0.05) and the correlation coefficient was - 0.947 ( P ＜ 0.05).The correlation coefficient between the latency of EEMG and the degree of NMB was 0.328 ( P ＜ 0.05).Conclusion When the degree of NMB is maintained at 25 ％-50％,facial nerve EEMG can be monitored effectively and body movement can be avoided during resection of acoustic neuroma.