昆明医科大学学报
昆明醫科大學學報
곤명의과대학학보
Journal of Kunming Medical University
2014年
1期
51-55
,共5页
角述兰%张玉龙%杨娟%汪露%李怡
角述蘭%張玉龍%楊娟%汪露%李怡
각술란%장옥룡%양연%왕로%리이
麻醉药%吸入%诱发电位%七氟醚%地氟醚
痳醉藥%吸入%誘髮電位%七氟醚%地氟醚
마취약%흡입%유발전위%칠불미%지불미
Anesthetics%Inhalation%Somatosensory evoked potentials%Sevoflurane%Desflurane
目的：比较地氟醚和七氟醚对神经外科手术术中体感诱发电位（somatosensory evoked potentials， SEP）的影响．方法选择ASA分级I～Ⅱ级，择期脊柱畸形矫形手术术中行SEP监测的患者30例，每例应用地氟醚和七氟醚，分为地氟醚组和七氟醚组（n＝30）．术中监测脑电双频指数（bispectral index，BIS）、肌松、SEP和血流动力学．维持BIS范围35～45，肌松消失，血流动力学平稳，调节吸入麻醉药的呼气末浓度为0.3、0.6和0.9最低肺泡有效浓度（minimum alveolar concentration，MAC）时分别吸入不同浓度麻醉药．记录四肢吸入麻醉药前（基础值）、达到各呼气末浓度（T1、T2、T3）和吸入麻醉药吹尽时（回归值） SEP的潜伏期和波幅，并计算与基础值比较所得的百分率．结果与基础值的潜伏期比较，左上肢、左下肢和右下肢地氟醚组T1、T2及T3，右上肢地氟醚组T2及T3，左上肢、左下肢和右上肢七氟醚组T2及T3，右下肢七氟醚组T1、T2及T3的潜伏期延长（＜0.05），其百分率随着吸入麻醉药物剂量的增加，潜伏期随之延长；与基础值的波幅比较，左上肢、左下肢地氟醚组T1、T2及T3，右上肢地氟醚组T1，右下肢地氟醚组T1及T2，左上肢七氟醚组T1，左下肢七氟醚组T1及T3的波幅下降（＜0.05），尤其在T1时下降最明显．与地氟醚比较，左上肢和左下肢T1、T2、T3的潜伏期和波幅、右上肢和右下肢T2、T3的潜伏期和右下肢T1的波幅，七氟醚的抑制作用小（＜0.05）．结论地氟醚和七氟醚对SEP均有抑制作用，随着剂量的加大，抑制作用逐渐增强，并且地氟醚的抑制作用强于七氟醚．
目的：比較地氟醚和七氟醚對神經外科手術術中體感誘髮電位（somatosensory evoked potentials， SEP）的影響．方法選擇ASA分級I～Ⅱ級，擇期脊柱畸形矯形手術術中行SEP鑑測的患者30例，每例應用地氟醚和七氟醚，分為地氟醚組和七氟醚組（n＝30）．術中鑑測腦電雙頻指數（bispectral index，BIS）、肌鬆、SEP和血流動力學．維持BIS範圍35～45，肌鬆消失，血流動力學平穩，調節吸入痳醉藥的呼氣末濃度為0.3、0.6和0.9最低肺泡有效濃度（minimum alveolar concentration，MAC）時分彆吸入不同濃度痳醉藥．記錄四肢吸入痳醉藥前（基礎值）、達到各呼氣末濃度（T1、T2、T3）和吸入痳醉藥吹儘時（迴歸值） SEP的潛伏期和波幅，併計算與基礎值比較所得的百分率．結果與基礎值的潛伏期比較，左上肢、左下肢和右下肢地氟醚組T1、T2及T3，右上肢地氟醚組T2及T3，左上肢、左下肢和右上肢七氟醚組T2及T3，右下肢七氟醚組T1、T2及T3的潛伏期延長（＜0.05），其百分率隨著吸入痳醉藥物劑量的增加，潛伏期隨之延長；與基礎值的波幅比較，左上肢、左下肢地氟醚組T1、T2及T3，右上肢地氟醚組T1，右下肢地氟醚組T1及T2，左上肢七氟醚組T1，左下肢七氟醚組T1及T3的波幅下降（＜0.05），尤其在T1時下降最明顯．與地氟醚比較，左上肢和左下肢T1、T2、T3的潛伏期和波幅、右上肢和右下肢T2、T3的潛伏期和右下肢T1的波幅，七氟醚的抑製作用小（＜0.05）．結論地氟醚和七氟醚對SEP均有抑製作用，隨著劑量的加大，抑製作用逐漸增彊，併且地氟醚的抑製作用彊于七氟醚．
목적：비교지불미화칠불미대신경외과수술술중체감유발전위（somatosensory evoked potentials， SEP）적영향．방법선택ASA분급I～Ⅱ급，택기척주기형교형수술술중행SEP감측적환자30례，매례응용지불미화칠불미，분위지불미조화칠불미조（n＝30）．술중감측뇌전쌍빈지수（bispectral index，BIS）、기송、SEP화혈류동역학．유지BIS범위35～45，기송소실，혈류동역학평은，조절흡입마취약적호기말농도위0.3、0.6화0.9최저폐포유효농도（minimum alveolar concentration，MAC）시분별흡입불동농도마취약．기록사지흡입마취약전（기출치）、체도각호기말농도（T1、T2、T3）화흡입마취약취진시（회귀치） SEP적잠복기화파폭，병계산여기출치비교소득적백분솔．결과여기출치적잠복기비교，좌상지、좌하지화우하지지불미조T1、T2급T3，우상지지불미조T2급T3，좌상지、좌하지화우상지칠불미조T2급T3，우하지칠불미조T1、T2급T3적잠복기연장（＜0.05），기백분솔수착흡입마취약물제량적증가，잠복기수지연장；여기출치적파폭비교，좌상지、좌하지지불미조T1、T2급T3，우상지지불미조T1，우하지지불미조T1급T2，좌상지칠불미조T1，좌하지칠불미조T1급T3적파폭하강（＜0.05），우기재T1시하강최명현．여지불미비교，좌상지화좌하지T1、T2、T3적잠복기화파폭、우상지화우하지T2、T3적잠복기화우하지T1적파폭，칠불미적억제작용소（＜0.05）．결론지불미화칠불미대SEP균유억제작용，수착제량적가대，억제작용축점증강，병차지불미적억제작용강우칠불미．
Objective To compare the effects of desflurane and sevoflurane on somatosensory evoked potentials (SEP) in patients undergoing spine neurosurgery. Methods Thirty patients with ASA grades I-Ⅱand undergoing spinal deformity orthopaedic surgery were selected and divided into two groups: desflurane group and sevoflurane group (n=30) . Bispectral index (BIS),the state of muscle relaxation, SEP and hemodynamics were monitored during operation. By maintaining the BIS in the range of 35-45,the state of muscle relaxation disappeared and hemodynamic became stable. Adjust the concentration of anesthetic step by step from 0 to 0.3, 0.6 and 0.9 maximum alveolar concentrations (MAC), then inhaled different concentrations of drugs. Record the incubation period and amplitude of SEP before inhaling anesthetics (based on the value), in the moment of achieving each inhaled concentration ( T1, T2 and T3) , and the moment that the inhaled anesthetics blows completely (regression value) . The percentages of T1, T2, T3, and the regression value compared with basic value were calculated.Results Compared with the basic value, T1, T2 and T3 of left arm, left leg and right leg in desflurane group, T2 and T3 of right arm in desflurane group, T2 and T3 of left arm, left leg and right arm in sevoflurane group,and T2 and T3 of right leg in sevoflurane group showed incubation period delaying ( <0.05) . And the incubation period extended along with the increase of inhaled anesthetics dosage. Compared with the basic value,T1,T2 and T1 of left arm and left leg in desflurane group,T1 of right arm in desflurane group, T1 and T2 of right leg in desflurane, T3 of left arm in sevoflurane group, T1 and T3 in left leg in sevoflurane group had decreased amplitude ( < 0.05), especially T1. Compared with desflurane, sevoflurane showed a weaker inhibition effect on the incubation period and amplitude of T1,T2,T3 of left arm and left leg,T2 and T3 of right arm and right leg, and the amplitude of T1 of right leg ( < 0.05) . Conclusion Both of desflurane and sevoflurane have inhibition effect on SEP. The inhibition effect gradually strengthens along with the increasing of dose. The inhibition effect of desflurane is stronger than sevoflurane.
