CAJ | 학술논문

目的观察1倍ED95顺阿式曲库铵用于麻醉诱导对甲状腺手术患者术中喉返神经监测的影响.方法择期甲状腺手术患者79例,采用随机数字表法,将其分为2组:Ⅰ组(n=40)和Ⅱ组(n=39).依次静脉注射咪达唑仑2 mg、异丙酚2 mg/kg、舒芬太尼0.5μg/kg,睫毛反射消失后,Ⅰ组静脉注射顺式阿曲库铵0.05 mg/kg,5 min插入喉返神经监测专用气管导管;Ⅱ组吸入七氟醚,呼气末浓度达到4％时插入喉返神经监测专用气管导管,吸入七氟醚维持麻醉.记录各组气管插管条件评分;采用神经肌电监测仪监测喉返神经诱发肌电位,于手术40 min时每隔5 min记录肌电信号,直到手术80 min;实验过程中监测收缩压(SBP)、舒张压(DBP)和心率(HR).结果两组Cooper评分,Ⅰ组为8.6±1.3,Ⅱ组为7.5±2.2.与Ⅱ组比较,Ⅰ组麻醉医生对气管插管条件评价较高(P＜0.05);两组不同时点神经肌电信号波幅值分别为,Ⅰ组为(1 163±723)、(1 196±787)、(1 201 ±987)、(1 287±946)、(1 258±836)、(1 306±963)、(1 327±954)、(1 306±824)、(1 316±967) μV;Ⅱ组为(1659±1 140)、(1 684±1 032)、(1 689±983)、(1 698±1 040)、(1 606±939)、(1 623 ±891)、(1 597±961)、(1 683±962)、(1 591 ±908) μV.与Ⅱ组比较,Ⅰ组各时点肌电信号波幅降低(P＜0.05),而2组均测得迷走神经/喉返神经信号(V/R信号),信号连续性满足监测要求.术中DBP、SBP和HR均在正常范围内.结论 1倍ED95顺式阿曲库铵用于甲状腺手术患者麻醉诱导不影响术中喉返神经监测.
목적 관찰1배ED95순아식곡고안용우마취유도대갑상선수술환자술중후반신경감측적영향.방법 택기갑상선수술환자79례,채용수궤수자표법,장기분위2조:Ⅰ조(n=40)화Ⅱ조(n=39).의차정맥주사미체서륜2 mg、이병분2 mg/kg、서분태니0.5μg/kg,첩모반사소실후,Ⅰ조정맥주사순식아곡고안0.05 mg/kg,5 min삽입후반신경감측전용기관도관;Ⅱ조흡입칠불미,호기말농도체도4％시삽입후반신경감측전용기관도관,흡입칠불미유지마취.기록각조기관삽관조건평분;채용신경기전감측의감측후반신경유발기전위,우수술40 min시매격5 min기록기전신호,직도수술80 min;실험과정중감측수축압(SBP)、서장압(DBP)화심솔(HR).결과 량조Cooper평분,Ⅰ조위8.6±1.3,Ⅱ조위7.5±2.2.여Ⅱ조비교,Ⅰ조마취의생대기관삽관조건평개교고(P＜0.05);량조불동시점신경기전신호파폭치분별위,Ⅰ조위(1 163±723)、(1 196±787)、(1 201 ±987)、(1 287±946)、(1 258±836)、(1 306±963)、(1 327±954)、(1 306±824)、(1 316±967) μV;Ⅱ조위(1659±1 140)、(1 684±1 032)、(1 689±983)、(1 698±1 040)、(1 606±939)、(1 623 ±891)、(1 597±961)、(1 683±962)、(1 591 ±908) μV.여Ⅱ조비교,Ⅰ조각시점기전신호파폭강저(P＜0.05),이2조균측득미주신경/후반신경신호(V/R신호),신호련속성만족감측요구.술중DBP、SBP화HR균재정상범위내.결론 1배ED95순식아곡고안용우갑상선수술환자마취유도불영향술중후반신경감측.
Objective To investigate the effect of a single dose of cisatracurium induction on introperative recurrent laryngeal nerve monitoring nerve electromyographic signal.Methods Seventy-nine thyroid cancer or reoperative patients were divided into two groups:sevoflurane (group Ⅰ,n =40) and cisatracurium (group Ⅱ,n =39) by random.Proceed the muscle injection of penehyclidine hydrochloride 1 mg thirty minutes preoperative.Open the vein circuit after going into the operating room,routine monitoring electrocardiogram (ECG) and oxygen saturation (SpO2).Sevoflurane (group Ⅰ) were treated with midazolam 2 mg,propofol 2 mg/kg,sulfentanyl 0.5 μg/kg by vein,and manual control inhaled sevoflurane after patients lost consciousness.Insert the electromyographic (EMG) endotracheal tube with glidescope after the gas monitor showed twice macat at the end of breath.Cisatracurium (group Ⅱ) were treated with Midazolam 2 mg,Propofol 2 mg/kg,sulfentanyl 0.5 μg/kg and cisatracurium 0.05 mg/kg by vein.Insert the EMG endotracheal tube with glidescope 5 minutes later.Sevoflurane (group Ⅰ) insert the EMG endotracheal when the end of expiratory concentration reach 4 minimum alveolar concentration (MAC).Record the Cooper' s score for conditions of tracheal intubation in two groups.Both groups applied continuous sevoflurane inhalation to sustain,and intraoperative sustain the depth of anesthesia between 1.4 and 1.6 MAC.Record at the time of tube insertion,expose the vagus nerve within thirty minutes,use NIM-response 3.0 nerve EMG monitor from forty minutes,stimulate with 1 mA current,record the electromyographic signal every five minutes.Monitor forty-five minutes continuously and record the blood pressure and pulse at the same time.Results The Cooper' s score in two groups,group Ⅰ was8.6 ± 1.3,group Ⅱ was 7.5 ± 2.2.Cooper score of intubating conditions more significant difference in group,group Ⅰ can provide a more stable intubation conditions.The electromyographic signal in two groups,group Ⅰ was (1 163 ± 723),(1 196 ±787),(1 201±987),(1 287±946),(1 258±836),(1 306±963),(1 327±954),(1 306±824),(1 316±967) μV; groupⅡ was (1 659±1 140),(1 684±1 032),(1 689±983),(1 698 ± 1 040),(1 606 ±939),(1 623 ±891),(1 597 ±961),(1 683 ±962),(1 591 ±908) μV.Both groups of patients could measure the vagus nerve/recurrent laryngeal nerve signal (V/R Signal) at thirty minute,and the continuity of EMG signal satisfied the monitoring requirement.The comparison of the signal value of two groups didn' t have statistical significance.The blood pressure and pulse both had rising tendency before and after intubation,but didn' t have statistical significance.The blood pressure,pulse and intubation reaction of group Ⅰ were higher than group Ⅱ,but didn' t have statistical significance.Conclusion Two kinds of anesthesia induction methods both satisfied the need of intraoperative neurophysiological monitoring (IONM).However,a single dose (0.05 mg/kg) of cisatracurium was easy to accept by both patients and anesthesia doctors.