CAJ | 학술논문

目的探索全身麻醉时使用非去极化肌松剂完成术中面神经监测的可行性.方法 30例全凭静脉麻醉手术患者,术中进行体表面神经功能的监测时,使用肌松监测仪监测肌松程度,观察4个成串刺激反应比值(TOF)与面神经复合肌肉动作电位(CMAP)波幅波幅与潜伏期的关系.结果 30例患者中,当TOF值为1时,CMAP的波幅与无肌松状态下的波幅比较,差异有统计学意义,而当TOF值为2和3时,CMAP波幅变化差异无统计学意义;尤其是在TOF值为2时,已能记录到清晰的CMAP波形.结论在全凭静脉麻醉时,使用肌松监测的条件下,通过定量肌松的方法,行面神经监测是可行的.这样既能在术中为手术医生提供有效的面神经监测,避免手术操作对面神经的损害,又能避免患者因术中发生体动对手术及面神经本身造成影响和伤害,甚至导致严重的后果.
목적 탐색전신마취시사용비거겁화기송제완성술중면신경감측적가행성.방법 30례전빙정맥마취수술환자,술중진행체표면신경공능적감측시,사용기송감측의감측기송정도,관찰4개성천자격반응비치(TOF)여면신경복합기육동작전위(CMAP)파폭파폭여잠복기적관계.결과 30례환자중,당TOF치위1시,CMAP적파폭여무기송상태하적파폭비교,차이유통계학의의,이당TOF치위2화3시,CMAP파폭변화차이무통계학의의;우기시재TOF치위2시,이능기록도청석적CMAP파형.결론 재전빙정맥마취시,사용기송감측적조건하,통과정량기송적방법,행면신경감측시가행적.저양기능재술중위수술의생제공유효적면신경감측,피면수술조작대면신경적손해,우능피면환자인술중발생체동대수술급면신경본신조성영향화상해,심지도치엄중적후과.
Objective To study the feasibility of using non-depolarizing relaxant in intraoperative facial nerve monitoring(IFNM)during total intravenous anesthesia(TIVA).Methods Thirty adult patients,aged 37(20～50),with ASA class Ⅰ or Ⅱ,without disorder of facial nerve,underwent IFNM during TIVA,using fentanyl,midazolam,and propofol,to record the compound muscle action potentials (CMAPs)of the facial nerve.Train of four(TOF)pattern was used to evaluate the degree of peripheral neuromuscular blockade.The relationship between the TOF value and CMAP was studied.Results When the TOP value was 1 the wave amplitude of the CMAP of facial nerve was 0.19±0.08 mv,significantly lower than that when no muscle relaxant was used(2.72±0.34 mv,P＜0.01),however,when the TOF values were≥2 there were no statistically significant differences in the amplitude of the CMAP of facial nerve.In addition,clear graph of CMAP could be obtained when the TOF values were≥2.Conclusion IFNM can be safely and efficaciously performed when neuromuscular blockade is monitored carefully during TIVA.