右美托咪定用于运动诱发电位监测神经外科手术患者的安全性和可行性

摘要

目的：观察右美托咪定用于运动诱发电位(MEP)监测神经外科手术患者的安全性和可行性。方法选择择期全麻下需做 MEP 监测颅脑肿瘤切除术患者30例,男15例,女15例,年龄20~60岁,体重40~80 kg,ASA Ⅰ或Ⅱ级,随机分为两组：右美托咪定组(D 组)和对照组(C 组),每组15例。D 组在麻醉诱导前经静脉10 min 输注右美托咪定0.5μg/kg,随后以右美托咪定0.5μg·kg-1·h-1输注至术毕,C 组采取同样方法给予等容量生理盐水。于入室时(T0),切皮时(T1),停肌松药时(T2),停肌松药后50 min(T3)观察 HR、MAP 和 BIS 值；记录诱发 MEP 的电流强度,监测等待时间(停肌松药后至首次诱发 MEP 时间),T3时大鱼际肌 MEP(直接电刺激运动皮质诱发的大鱼际肌 MEP)的波幅及潜伏期；同时记录术中丙泊酚和瑞芬太尼的用量,不良反应发生情况。结果与T0时比较,T1、T3时 C 组 HR 明显增快(P <0.05),T2、T3时 D 组 HR 明显减慢(P <0.05), T1~T3时 C 组 MAP 明显升高(P <0.05),T1~T3时两组 BIS 值明显降低(P <0.05)；T1~T3时D 组 HR 明显慢于 C 组、MAP 明显低于 C 组(P <0.05)。D 组丙泊酚用量和首次诱发 MEP 的电流强度明显低于 C 组(P <0.05),T3时大鱼际肌 MEP 波幅明显高于 C 组(P <0.05)。D 组高血压和心动过速发生率明显低于 C 组、心动过缓发生率明显高于 C 组(P <0.05)。结论右美托咪定用于MEP 监测神经外科手术患者,可满足手术需求、维持围术期血流动力学稳定,降低部分不良反应发生率,改善 MEP 监测质量,是一种安全、可行的麻醉方法。%Objective To observe the feasibility and safety of dexmedetomidine used in motor evoked potentials(MEP)monitoring in patients undergoing neurosurgery.Methods Thirty ASA Ⅰ orⅡ patients,male 1 5 cases,female 1 5 cases,aged 20-60 years,weighing 40-80 kg undergoing neuro-surgery receiving MEP monitoring were randomly divided into 2 groups (n =1 5 each):control group (group C)and dexmedetomidine group (group D).In group D,dexmedetomidine 0.5 μg/kg was in-fused over 10 minutes before anesthesia induction,and then was infused at a rate of 0.5 μg·kg-1 · h-1 toward the end of operation.Group C received the equal volume of normal saline.HR,MAP and BIS were recorded at admission to the operating room (T0 ),skin incision (T1 ),when the muscle re-laxants were stopped (T2 )and 50 minutes later (T3 ).The current intensity and the time when first MEP was induced after muscle relaxant was stopped,the amplitudes and latencies of MEP on thenar muscle at T3 ,the total consumption of anesthetics,and development of adverse effects were also re-corded.Results Compared with T0 ,HR in group C at T1 ,T3 and MAP in group C at T1-T3 was in-creased,HR in group D was decreased at T2-T3 (P <0.05).Compared with group C,HR and MAP were decreased at T1-T3 in group D(P <0.05).The amount of propofol consumed and the current in-tensity inducing MEP were lower in group D than in group C (P <0.05).The amplitude of MEP at T3 was higher in group D than in group C (P <0.05).Compared with group C,the incidences of hy-pertension and tachycardia were decreased in group D,and the incidence of bradycardia was increased (P <0.05).Conclusion Dexmedetomidine used in MEP monitoring in patients undergoing neurosur-gery can meet the operation requirements,maintain hemodynamic stability,reduce the incidences of adverse reactions,and improve monitoring quality of MEP.It is a safe and feasible anesthesia method.