临床麻醉学杂志
臨床痳醉學雜誌
림상마취학잡지
THE JOURNAL OF CLINICAL ANESTHESIOLOGY
2014年
6期
561-563
,共3页
非去极化肌松药%面神经监测%脑电双频指数%四个成串刺激
非去極化肌鬆藥%麵神經鑑測%腦電雙頻指數%四箇成串刺激
비거겁화기송약%면신경감측%뇌전쌍빈지수%사개성천자격
Non-depolarizing muscle relaxant%Facial nerve monitoring%Bispectral index%Train of four stimulation
目的：探讨在后颅凹占位手术中采用全凭静脉麻醉方式,寻找不影响神经传导功能监测的合理肌松深度。方法选择后颅凹桥小脑角区(CPA)占位手术患者40例,随机分为两组：A 组不用肌松药,即采用常规麻醉方法,全麻诱导插管后到电生理监测结束前不用肌松药；B 组使用肌松药,即在电生理监测过程中维持 TOF 值2%~25%。所有患者采用全凭静脉麻醉,维持 BIS 值在40~60。记录不同 TOF 值时肌电图波幅。记录手术时间及丙泊酚、舒芬太尼、罗库溴铵的用量。记录患者围术期的 SBP、DBP、HR 及术前、术后1周、术后6个月的面神经功能。结果两组患者均顺利完成神经监测,A 组丙泊酚用量明显多于 B 组(P <0.05),A 组3例患者术中发生体动反应,B 组在TOF 为三个信号时有4例不能进行电生理监测。两组各时点 DBP、SBP、HR 及面神经功能差异无统计学意义。结论在非去极化肌松药辅助下维持 TOF 值在2%~25%不影响神经电生理监测,同时可避免术中出现体动反应并可减少镇静药物的用量。
目的：探討在後顱凹佔位手術中採用全憑靜脈痳醉方式,尋找不影響神經傳導功能鑑測的閤理肌鬆深度。方法選擇後顱凹橋小腦角區(CPA)佔位手術患者40例,隨機分為兩組：A 組不用肌鬆藥,即採用常規痳醉方法,全痳誘導插管後到電生理鑑測結束前不用肌鬆藥；B 組使用肌鬆藥,即在電生理鑑測過程中維持 TOF 值2%~25%。所有患者採用全憑靜脈痳醉,維持 BIS 值在40~60。記錄不同 TOF 值時肌電圖波幅。記錄手術時間及丙泊酚、舒芬太尼、囉庫溴銨的用量。記錄患者圍術期的 SBP、DBP、HR 及術前、術後1週、術後6箇月的麵神經功能。結果兩組患者均順利完成神經鑑測,A 組丙泊酚用量明顯多于 B 組(P <0.05),A 組3例患者術中髮生體動反應,B 組在TOF 為三箇信號時有4例不能進行電生理鑑測。兩組各時點 DBP、SBP、HR 及麵神經功能差異無統計學意義。結論在非去極化肌鬆藥輔助下維持 TOF 值在2%~25%不影響神經電生理鑑測,同時可避免術中齣現體動反應併可減少鎮靜藥物的用量。
목적：탐토재후로요점위수술중채용전빙정맥마취방식,심조불영향신경전도공능감측적합리기송심도。방법선택후로요교소뇌각구(CPA)점위수술환자40례,수궤분위량조：A 조불용기송약,즉채용상규마취방법,전마유도삽관후도전생리감측결속전불용기송약；B 조사용기송약,즉재전생리감측과정중유지 TOF 치2%~25%。소유환자채용전빙정맥마취,유지 BIS 치재40~60。기록불동 TOF 치시기전도파폭。기록수술시간급병박분、서분태니、라고추안적용량。기록환자위술기적 SBP、DBP、HR 급술전、술후1주、술후6개월적면신경공능。결과량조환자균순리완성신경감측,A 조병박분용량명현다우 B 조(P <0.05),A 조3례환자술중발생체동반응,B 조재TOF 위삼개신호시유4례불능진행전생리감측。량조각시점 DBP、SBP、HR 급면신경공능차이무통계학의의。결론재비거겁화기송약보조하유지 TOF 치재2%~25%불영향신경전생리감측,동시가피면술중출현체동반응병가감소진정약물적용량。
Objective To investigate the proper depth of muscle relaxant without affecting elec-trophysiological monitoring in patients undergoing posterior fossa surgery under total intravenous an-esthesia (TIVA).Methods Forty patients selected for posterior fossa surgery were randomly divided into two groups A and B.Group A:no muscle relaxants were administered after anesthesia induction until the EMG was completed.Group B:muscle relaxants maintained in range of TOF 2%-25% dur-ing electrophysiological monitor.TIVA were used to all patients and BIS was maintained in range of 40-60.Two electrophysiological data were applied during the electrophysiological monitoring:sponta-neity EMG and evoked EMG.EMG amplitude was recorded at different TOF value.Operation time and the dosages of propofol,sufentanil,rocuronium bromide were recorded.Also,the SBP,DBP,HR at perioperational period and facial nerve function before surgery,one week and six months after sur-gery were recorded.Results The electrophysiological monitoring completed successfully in all pa-tients.The total amount of propofol in group A significantly increased than those in group B(P <0.05).Three patients in group A had body movement during the operation.Four cases in group B couldn??t perform electrophysiological monitor when the TOF had three signals.There were no differ-ence between the two groups in SBP,DBP,HR and facial nerve function.Conclusion Maintaining TOF value in range of 2%-25% under non-depolarizing muscle relaxant during CPA surgery doesn??t affect intraoperative nerve electrophysiological monitor and prevent body movement,total dose of sed-ative anesthetics is also decresed.
