不同浓度七氟烷麻醉与不同刺激电压对脊髓手术中运动诱发电位波幅和潜伏期的影响

doi:10.3969/j.issn.1671-167X.2016.02.022

摘要/Abstract

摘要：

目的：评价七氟烷在不同呼气末浓度和不同刺激电压时对脊髓手术中运动诱发电位（motor evoked potentials，MEPs）监测的影响，为临床需要进行MEPs监测手术的麻醉用药提供选择依据。方法：选择年龄18~65岁、ASA Ⅰ~Ⅱ级、需择期行胸腰段脊髓肿瘤切除手术的患者48例。常规全身麻醉（全麻）诱导后，在手术重要操作步骤开始前分别测定刺激电压为300 V、400 V、500 V、600 V时和七氟烷呼气末浓度分别为0.0%、0.5%、1.0%、1.5%时的MEPs波幅和潜伏期。全麻期间瑞芬太尼的输注速度维持在0.2 μg/（kg·min），适当调整丙泊酚泵注速度维持脑电双频谱指数（bispectral index，BIS）在30～50范围内。结果：七氟烷呼气末浓度和电生理监测仪的刺激电压显著影响MEPs的波幅，在同一刺激电压下，随七氟烷呼气末浓度的提高，MEPs的波幅下降,呼气末浓度1.5%时MEPs波幅（左侧20.50 μV、70.71 μV、135.97 μV、190.00 μV，右侧14.29 μV、50.71 μV、73.10 μV、77.50 μV）明显低于呼气末浓度0.5%时MEPs波幅（左侧100.00 μV、362.57 μV、444.05 μV、435.00 μV ，右侧115.00 μV、207.15 μV、258.34 μV、358.50 μV）以及0.0%时MEPs波幅（左侧143.00 μV、388.10 μV、484.53 μV、500.00 μV，右侧176.00 μV、407.60 μV、384.35 μV、451.00 μV），差异有统计学意义（左侧χ2= 27.46, P< 0.01，右侧χ2=60.49, P< 0.01；左侧χ2= 20.73, P< 0.01，右侧 χ2=55.05,P< 0.01；左侧χ2= 34.25,P< 0.01，右侧χ2=33.58,P< 0.01；左侧χ2= 28.61,P< 0.01，右侧 χ2= 49.04,P< 0.01）；MEPs的潜伏期也有延长，但结果差异无统计学意义（P=0.26）。同一呼气末浓度下，随刺激电压的增大，MEPs波幅增高，电压300 V时MEPs波幅（左侧 143.00 μV、100.00 μV、61.50 μV、20.50 μV，右侧176.00 μV、115.00 μV、41.07 μV、14.29 μV）明显低于400 V时MEPs波幅（左侧388.10 μV、362.57 μV、198.81 μV、70.71 μV，右侧407.60 μV、207.15 μV、89.00 μV、50.71 μV）、500 V时MEPs波幅（左侧484.53 μV、444.05 μV、216.24 μV、135.97 μV，右侧 384.35 μV、258.34 μV、187.50 μV、73.10 μV）与600 V时MEPs波幅（左侧500.00 μV、435.00 μV、344.00 μV、190.00 μV，右侧451.00 μV、385.50 μV、156.00 μV、77.50 μV），差异有统计学意义（左侧χ2= 45.55,P< 0.01，右侧χ2= 25.73,P< 0.01；左侧χ2= 46.67,P< 0.01，右侧χ2= 55.30,P< 0.01；左侧χ2= 47.36,P< 0.01，右侧χ2= 47.82,P< 0.01；左侧χ2= 38.67,P< 0.01 ，右侧χ2= 45.87,P< 0.01）。同一呼气末浓度下，随刺激电压的增大，MEPs的潜伏期逐渐缩短，电压300 V时MEPs潜伏期与400 V、500 V、600 V MEPs潜伏期比较差异有统计学意义（左侧 F=7.50，P=0.01；右侧F=13.33，P<0.01），但是这种潜伏期的变化没有临床意义。同一刺激电压下，随七氟烷呼气末浓度的提高，MEPs的成功率下降，呼气末浓度1.5%时MEPs的成功率(左侧43.8%、70.8%、77.1%、81.3%，右侧37.5%、60.4%、75.0%、66.7%)明显低于呼气末浓度0.5%时MEPs的成功率（左侧72.9%、89.6%、95.8%、95.8%，右侧66.7%、89.6%、95.8%、97.9%）及0.0%时MEPs的成功率（左侧79.2%、87.5%、95.8%、93.8% ，右侧75.0%、95.8%、95.8%、95.8%），而同一呼气末浓度下，增大刺激电压可以提高MEPs的成功率，电压300 V时MEPs的成功率（左侧79.2%、72.9%、62.5%、43.8%，右侧75.0%、66.7%、60.4%、37.5%）明显低于400 V MEPs的成功率（左侧87.5%、89.6%、77.1%、70.8%，右侧95.8%、89.6%、79.2%、60.4%）、500 V MEPs的成功率（95.8%、95.8%、91.7%、77.1%，右侧95.8%、95.8%、81.3%、75.0%）以及600 V时MEPs的成功率（左侧93.8%、95.8%、89.6%、81.3%，右侧95.8%、97.9%、89.6%、66.7%），刺激电压600 V、七氟烷呼气末浓度为1.5%时MEPs的成功率与刺激电压300 V、七氟烷呼气末浓度为0.0%时MEPs的成功率差异无统计学意义（P=0.22）。结论：七氟烷对术中MEPs监测具有剂量依赖性抑制作用，但通过增加刺激电压，可以增大MEPs的波幅，缩短MEPs的潜伏期，提高MEPs监测的成功率，扩大了七氟烷在脊髓功能监测手术中的适用范围。

关键词: 诱发电位, 运动, 七氟醚, 脊髓, 外科手术, 麻醉, 吸入

Abstract:

Objective： To evaluate the effects of increasing end-tidal concentrations of sevoflurane and increasing stimulation voltage on motor evoked potentials, so as to provide evidence in making anesthesia plan for intraspinal tumor surgery. Methods: In the study, 48 patients scheduled to undergo intraspinal tumor surgery ［American Society of Anesthesiology,(ASA) Ⅰ-Ⅱ, 18-65 years old］ were enrolled. After general anesthesia induction, the patients were assigned to receive sevoflurane anesthesia of increa-sing end-tidal concentration in the sequence of 0.0%, 0.5%, 1.0% and 1.5% respectively, under a background of propofol and remifentanil. All the observations were done before the important steps of surgery. Remifentanil infusion rate was 0.2 μg /(kg·min), while the propofol infusion rate was adjusted to maintain the bispectral index values within the range of 30-50. At each concentration, 4 stimulation voltages of 300 V, 400 V, 500 V and 600 V were employed to elicit motor evoked potentials (MEPs). The amplitude and latency of each MEP were compared. The success ratio was also recorded. Results: The concentration of sevoflurane and the stimulation voltage had impacts on the amplitude and latency of MEPs. Under each stimulation voltage, the MEPs amplitude decreased following increasing end-tidal sevoflurane concentrations, and significant differences were found in comparing 1.5% sevoflurane (left 20.50 μV, 70.71 μV, 135.97 μV, 190.00 μV , right 14.29 μV, 50.71 μV, 73.10 μV, 77.50 μV) with 0.0% sevoflurane (left 143.00 μV, 388.10 μV, 484.53 μV, 500.00 μV, right 176.00 μV, 407.60 μV, 384.35 μV, 451.00 μV) and 0.5% sevoflurane (left 100.00 μV, 362.57 μV, 444.05 μV, 435.00 μV, right 115.00 μV, 207.15 μV, 258.34 μV, 358.50 μV), left χ2= 27.46,P<0.01, right χ2= 60.49,P<0.01；left χ2= 20.73,P<0.01, right χ2= 55.05,P<0.01；left χ2= 34.25,P<0.01,right χ2=33.58,P<0.01；left χ2= 28.61,P<0.01 ,right χ2= 49.04,P<0.01; while there were no statistical differences in the latency changes (P=0.26). Under each end-tidal sevoflurane concentration, the MEPs amplitude increased following increasing stimulation voltages, and significant differences were found in comparing 300 V (left 143.00 μV, 100.00 μV, 61.50 μV, 20.50 μV , right 176.00 μV, 115.00 μV, 41.07 μV, 14.29 μV) with 400 V (left 388.10 μV, 362.57 μV, 198.81 μV, 70.71 μV, right 407.60 μV, 207.15 μV, 89.00 μV, 50.71 μV) and 500 V (left 484.53 μV, 444.05 μV, 216.24 μV, 135.97 μV, right 384.35 μV, 258.34 μV, 187.50 μV, 73.10 μV) and 600 V (left 500.00 μV, 435.00 μV, 344.00 μV, 190.00 μV, right 451.00 μV, 385.50 μV, 156.00 μV, 77.50 μV), left χ2= 45.55,P<0.01, right χ2= 25.73,P<0.01; left χ2= 46.67,P<0.01, right χ2= 55.30,P<0.01；left χ2= 47.36,P<0.01,right χ2= 47.82,P<0.01; left χ2= 38.67,P<0.01, right χ2= 45.87,P<0.01; while the latencies were decreased， and significant dif-ferences were found in comparing 300 V with 400 V and 500 V and 600V（left F=7.50，P=0.01 , right F=13.33，P<0.01）, but the differences had little clinical significance. The success ratio decreased by increasing end-tidal sevoflurane concentration, and significant differences were found in comparing 1.5% sevoflurane (left 43.8%，70.8%，77.1%，81.3%, right 37.5%，60.4%，75.0%，66.7%) with 0.0% sevoflurane (left 79.2%，87.5%，95.8%，93.8%, right 75.0%，95.8%，95.8%， 95.8%) and 0.5% sevoflurane (left 72.9%，89.6%，95.8%，95.8%, right 66.7%，89.6%，95.8%， 97.9%); the success ratio increased by increasing stimulation voltage, and significant differences were found in comparing 300 V（left 79.2%，72.9%，62.5%，43.8%, right 75.0%，66.7%，60.4%， 37.5%）with 400 V（left 87.5%，89.6%，77.1%，70.8% , right 95.8%，89.6%，79.2%，60.4%）and 500 V（left 95.8%，95.8%，91.7%，77.1%, right 95.8%，95.8%，81.3%，75.0%）and 600 V (left 93.8%， 95.8%，89.6%，81.3%, right 95.8%，97.9%，89.6%，66.7%）, but there were no statistical differences in the success ratio of MEPs between the group with stimulation voltage of 600 V , end tidal sevoflurane concentration of 1.5% and the group with stimulation voltage of 300 V, end tidal sevoflurane concentration of 0.0% (P=0.22). Conclusion: Sevoflurane inhibited MEPs in a dose-dependent manner. It can decrease the amplitudes and prolong the latencies. But increasing stimulation voltage will facilitate MEPs monitoring and increase the success ratio. Sevoflurane can be used in larger parts of MEPs monitoring surgery by increasing the stimulation voltage.

Key words: Evoked potentials, motor, Sevoflurane, Spinal cord, Surgical procedures, operative, Anesthesia, inhalation

中图分类号:

R614.21

王丽薇，孟秀丽，郭向阳，赵薇，王振宇. 不同浓度七氟烷麻醉与不同刺激电压对脊髓手术中运动诱发电位波幅和潜伏期的影响[J]. 北京大学学报(医学版), 2016, 48(2): 297-303.

WANG Li-wei， MENG Xiu-li， GUO Xiang-yang， ZHAO Wei， WANG Zhen-yu. Influence of sevoflurane concentration and stimulation voltage on motor evoked potentials in intraspinal tumor surgery[J]. Journal of Peking University(Health Sciences), 2016, 48(2): 297-303.

参考文献

相关文章 15

[1]	苏俊琪,宋扬,谢尚. 口腔鳞状细胞癌患者修复重建术后感染的病原学特征及感染风险预测模型的构建[J]. 北京大学学报（医学版）, 2022, 54(1): 68-76.
[2]	穆东亮,薛铖,安彬,王东信. 硬膜外阻滞与结直肠癌患者术后远期生存状态的关系:一项倾向性评分匹配的回顾性研究[J]. 北京大学学报（医学版）, 2021, 53(6): 1152-1158.
[3]	刘梅歌,方朴,王严,丛璐,范洋溢,袁远,徐燕,张俊,洪道俊. 远端型遗传性运动神经病8例的临床、病理及遗传学特点[J]. 北京大学学报（医学版）, 2021, 53(5): 957-963.
[4]	王新宇,崔哲,和清源,邓湘宁,郭歌,冯新恒,冯杰莉. 斑点追踪技术评价中国优秀男子举重运动员心脏的改变[J]. 北京大学学报（医学版）, 2021, 53(5): 832-837.
[5]	蒋青,张雨. 新形势下运动损伤特点及细胞生物治疗的应用前景和挑战[J]. 北京大学学报（医学版）, 2021, 53(5): 828-831.
[6]	敖英芳. 我国运动医学发展与北京冬奥会和健康中国建设[J]. 北京大学学报（医学版）, 2021, 53(5): 823-827.
[7]	杨渝平,孔思敏,邓佳良,蒋艳芳,敖英芳. 休闲滑雪者和滑雪运动员急性运动损伤的比较[J]. 北京大学学报（医学版）, 2021, 53(5): 838-842.
[8]	朱敬先,鲁胜楠,蒋艳芳,姜玲,王健全. 老年肩袖损伤手术患者术前肺功能的影响因素[J]. 北京大学学报（医学版）, 2021, 53(5): 902-906.
[9]	杨渝平,马骁,陈拿云,蒋艳芳,张晓伟,丁中伟,刘涛,敖英芳. 冬奥会雪场医疗站和近地医疗保障医院在滑雪运动伤救治体系中的作用[J]. 北京大学学报（医学版）, 2021, 53(3): 580-585.
[10]	林国中, 马长城, 王振宇, 谢京城, 刘彬, 陈晓东. 颈_1~2硬膜外神经鞘瘤的显微微创治疗[J]. 北京大学学报（医学版）, 2021, 53(3): 586-589.
[11]	李新飞, 彭意吉, 余霄腾, 熊盛炜, 程嗣达, 丁光璞, 杨昆霖, 唐琦, 米悦, 吴静云, 张鹏, 谢家馨, 郝瀚, 王鹤, 邱建星, 杨建, 李学松, 周利群. 肾部分切除术前CT三维可视化评估标准的初步探究[J]. 北京大学学报（医学版）, 2021, 53(3): 613-622.
[12]	耿志宇,高为华,王东信. 全身麻醉气管插管患者术后声带运动不良的临床结局[J]. 北京大学学报（医学版）, 2021, 53(2): 337-340.
[13]	杨渝平,马骁,陈拿云,蒋艳芳,张晓伟,丁中伟,敖英芳. 中国崇礼某大型雪场大众滑雪者损伤情况分析[J]. 北京大学学报（医学版）, 2021, 53(2): 273-278.
[14]	杨阳,肖锋,王进,宋波,李西慧,张师杰,何志嵩,张寰,尹玲. 同期手术治疗心脏病和非心脏疾病[J]. 北京大学学报（医学版）, 2021, 53(2): 327-331.
[15]	孟昭婷,穆东亮. 肺叶切除术中少尿与术后急性肾损伤的关系[J]. 北京大学学报（医学版）, 2021, 53(1): 188-194.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed