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诱发电位,运动

诱发电位,运动的相关文献在2001年到2020年内共计125篇,主要集中在外科学、神经病学与精神病学、基础医学 等领域,其中期刊论文123篇、专利文献318674篇;相关期刊48种,包括法医学杂志、解剖与临床、中国微侵袭神经外科杂志等; 诱发电位,运动的相关文献由548位作者贡献,包括乔慧、杨军林、万勇等。

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诱发电位,运动—发文趋势图

诱发电位,运动

-研究学者

  • 乔慧
  • 杨军林
  • 万勇
  • 李佛保
  • 陈裕光
  • 刘莉
  • 彭新生
  • 郑召民
  • 叶红
  • 尹厚民
  • 期刊论文
  • 专利文献

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    • 贺晶; 周文静; 林久銮; 宋宪成; 阮静; 李佳
    • 摘要: 目的 探讨功能磁共振成像(fMRI)结合术中神经电生理技术在药物难治性癫痫患者运动区定位中的应用价值.方法 回顾性分析2018年6月至2019年4月清华大学玉泉医院癫痫中心行癫痫灶切除术治疗的9例难治性癫痫患者的临床资料.患者的中位年龄为15岁(2~31岁).所有患者术前行头颅MRI、弥散张量成像(DTI)及血氧水平依赖(BOLD)成像-fMRI检查,初步定位病灶和运动功能区.术中应用神经电生理监测运动诱发电位(MEP)确认运动功能区,同时应用手术神经导航系统定位病灶区域及功能区.手术切除病灶的同时行神经电生理监测,以避开功能区、最大程度地切除病灶.术后复查头颅CT,观察有无水肿、出血.比较手术前后及随访3个月时患者的肌力情况,作为保护运动区效果的评估指标.结果 9例患者DTI结果均清晰地显示病灶、病灶周围与大脑脚之间的运动纤维联系.9例患者中,4例术前BOLD-fMRI结果与术中神经电生理监测的MEP定位的功能区一致,1例为部分一致,4例不一致.9例患者的致痫灶完全切除.术后5例患者出现不同程度的肌力下降,此5例患者头颅CT出现轻微脑水肿,1周后缓解.无一例颅内出血.术后3个月随访时,8例患者未见癫痫发作,仅1例患者仍有癫痫发作,发作频率下降;8例患者的肌力水平同术前,1例患者的肌力较术前改善.结论 术前BOLD-fMRI、DTI结合术中神经电生理技术可定位药物难治性癫痫患者的运动区,对其运动功能有较好的保护作用.
    • 曹静; 梁治; 刘进德; 高璐超; 步雪静; 康静超; 赵月; 徐雪
    • 摘要: 目的 评价不同剂量顺式阿曲库铵对颅内动脉瘤夹闭术患者运动诱发电位(MEP)监测的影响.方法 择期全麻下行颅内动脉瘤夹闭术患者80例,性别不限,年龄18~64岁,体重指数<30 kg/m2,ASA分级Ⅰ或Ⅱ级,Hunt-Hess分级0-Ⅱ级.采用随机数字表法分为4组(n=20):常规组(R组)和不同剂量顺式阿曲库铵组(Cis1-3组).麻醉诱导后行肌松监测,采用四个成串刺激(TOF)模式(频率2Hz,波宽0.2 ms,串间间隔15s)刺激前臂尺神经,记录TOF比值作为基础值(T1).麻醉诱导后采用神经电生理监测仪监测MEP.TOF比值恢复至基础值且MEP可有效引出时,Cis1-3组分别静脉输注顺式阿曲库铵0.625、0.833、1.000 μg·kg-1·min-1,R组静脉输注等容量生理盐水.分别于T1、剪开硬脑膜即刻(T2)、夹闭动脉瘤即刻(T3)和缝合硬脑膜结束即刻(T4)记录TOF比值;记录术中MEP有效引出情况;记录术中心血管事件、自主呼吸恢复及体动等发生情况.结果 与R组比较,Cis1组各时点TOF比值差异无统计学意义(P>0.05),Cis2组T2-4时TOF比值降低,Cis3组T2-4时TOF比值降低(P<0.05);与Cis1组比较,Cis2组T3,4时TOF比值降低,Cis3组T2-4时TOF比值降低(P<0.05).4组MEP有效引出率均为100%.4组术中心血管事件、自主呼吸恢复及体动发生率比较差异无统计学意义(P>0.05).结论 静脉输注顺式阿曲库铵0.833~1.000 μg·kg-1·min-1用于颅内动脉瘤夹闭术患者可维持一定肌松程度,又不会对MEP监测产生影响.
    • 陶晓蓉; 王明然; 王荣; 李志保; 樊星; 张力伟; 乔慧
    • 摘要: 目的 初步探讨术中直接电刺激运动诱发电位(DES-MEP)在脑干肿瘤手术中对运动功能的保护作用.方法 纳入2017年1月至2020年5月行脑干肿瘤切除术患者共136例,术中常规行电生理监测联合神经导航(对照组,68例)或常规电生理与DES-MEP监测联合神经导航(联合监测组,68例),根据手术前后肌力变化(Lovett肌力分级)判断是否存在新发运动障碍,以术中DES-MEP监测和术后运动功能评价结果判断DES-MEP监测的真阳性、假阳性、真阴性、假阴性,并计算其预测术后运动功能预后的灵敏度与特异度、阳性预测值与阴性预测值、准确率.结果 联合监测组患者术后2周出现严重新发运动障碍(Lovett肌力分级降低≥2级)的比例为16.18%(11/68),低于对照组[32.35%(22/68);x2=4.841,P=0.028].DES-MEP监测真阳性者44例、假阳性4例、真阴性7例、假阴性13例,术后预测严重新发运动障碍的灵敏度为77.19%(44/57)、特异度7/11,阳性预测值91.67%(44/48)、阴性预测值35%(7/20),诊断准确率为75%(51/68).结论 脑干肿瘤切除手术中常规电生理监测与DES-MEP监测技术联合应用,可实现对脑干运动功能的保护,弥补现阶段术中电生理监测技术在皮质脊髓束功能保护方面的不足.
    • 宗轶烃; 沈琦; 肖明; 方媛; 毛庆
    • 摘要: 目的 探讨全身麻醉状态下邻近运动功能区胶质瘤手术中运动诱发电位(MEP)监测对术后新发/加重运动障碍的预测价值.方法 以2019年10月至2020年3月接受邻近运动功能区胶质瘤手术的49例患者为研究对象,术中采取经颅电刺激(TES)、直接皮质电刺激(DCS)或皮质下电刺激(SCS),记录对侧肢体和面部肌肉的运动诱发电位,以定位大脑运动皮质和皮质脊髓束.运动诱发电位的预警标准为TES-MEP波幅降低≥50%或DCS-MEP波幅降低≥50%;以英国医学研究学会(MRC)肌力分级为“金标准”,计算TES-MEP、DCS-MEP和SCS-MEP预测术后新发/加重运动障碍的灵敏度与特异度、阳性预测值与阴性预测值.结果 49例患者均诱发出TES-MEP,真阳性2例、真阴性44例、假阴性3例;有11例诱发出DCS-MEP,真阳性1例、真阴性10例;TES-MEP预测术后新发/加重运动障碍灵敏度为2/5、特异度100% (44/44)、阳性预测值为2/2、阴性预测值93.62% (44/47);DCS-MEP预测灵敏度为1/1、特异度10/10,阳性预测值为1/1、阴性预测值10/10.共5例(10.20%)患者术后出现新发/加重运动障碍,随访至术后3个月,1例肌力恢复正常;TES-MEP预测灵敏度为2/4、特异度100%(45/45),阳性预测值为2/2、阴性预测值95.74%(45/47);DCS-MEP预测灵敏度为1/1、特异度10/10,阳性预测值为1/1、阴性预测值10/10.结论 术中TES-MEP监测假阴性率较高,DCS-MEP与术后运动功能预后一致性较高,但是由于无法显露中央前回皮质使其应用率较低.推荐联合应用TES-MEP、DCS-MEP和SCS-MEP判断运动传导通路完整性,效果更佳.
    • Ma Shanfeng; Ma Kui; Lyu Hezuo
    • 摘要: Objective To investigate the correlation between motor evoked potential ( MEP) and Basso-Beattie-Bresnahan (BBB) scores in evaluating spinal cord injury function in rats. Methods Sixteen adult female SD rats were randomly divided into control group and experimental group with 8 rats in each group. The animals of control group were only operated without external force, and the animals of experimental group were made the spinal cord injury ( SCI) model used PSI-IH device. The spinal cord motor evoked potential (scMEP) and muscle motor evoked potential ( mMEP) were recorded and analyzed before injury and 3 h, 1 d, 3 d, and the 1st, 2nd, 3rd, 4th, 5th, 6th weeks after injury. The motor function of hind limbs was evaluated by BBB score. The histological changes of spinal cord were observed 6 weeks after SCI. Results After SCI, the amplitude of scMEP in the experimental group decreased to 32.69% ± 0.83% of the normal amplitude at 3 hours, and it reached 52.93% ± 2.23% of the normal amplitude at 2 weeks later, which was stable, but was lower than that of control group ( all P values <0.01); the mMEP waveform disappeared at 3 hours after SCI, and it reached to 1.16% ± 0.17% of the normal amplitude after one day of injury. 4th week after SCI, the amplitude of mMEP was 48.20% ± 3.70% of normal amplitude and was stable, but it was lower than that of the control group (all P values< 0.01). The BBB score in the experimental group were 0 at 3 hours and 1 day after SCI. The BBB scores were 1.38 ± 0.52 after 3 days and which were 11.50 ± 0.93 after 4 weeks, reaching a stable state, but they were lower than those of the control group ( all P values<0.01). In the experimental group, there was a significant correlation between scMEP and BBB score (r 0.732-0.908, all P values<0.05) from 3 h to 6th week after SCI. There was a moderate or high correlation between mMEP and BBB score in the experimental group from 1st to 6th week after SCI (r 0.718-0.951, all P values<0.05). There were no significant changes in the above indexes of the control group. Conclusions After SCI in rats, scMEP, mMEP and BBB scores will be recovered sequentially, and are correlated to some extent. In addition, scMEP and mMEP are more sensitive indicators of SCI than BBB scores.%目的 探讨大鼠脊髓损伤功能评价指标运动诱发电位( MEP)和 Basso-Beattie-Bresnahan (BBB)评分的相关性.方法 成年雌性SD大鼠16只,采用数字表法随机分为对照组和实验组,每组8只.对照组只施行手术,不给予外力打击.实验组应用PSI-IH装置复制脊髓损伤模型.记录并分析损伤前以及损伤后3 h、1 d、3 d、1周、2周、3周、4周、5周、6周大鼠脊髓运动诱发电位(scMEP)和肌肉运动诱发电位(mMEP),同时采用BBB评分对大鼠后肢运动功能进行评定. 6周后观察大鼠脊髓组织学结构变化.结果 实验组大鼠脊髓损伤后3 h scMEP波幅减小,为正常波幅的32.69% ± 0.83% ,2周后为正常波幅的52.93% ± 2.23%并处于稳定状态,但均低于对照组( P值均<0.01);损伤后3 h mMEP波形消失,1 d后恢复至正常波幅的1.16% ± 0.17% ,3 d后波幅明显恢复,4周后达正常波幅的48.20% ± 3.70%并处于稳定状态,但均低于对照组( P值均<0.01).实验组大鼠脊髓损伤后3 h和1 d,所有大鼠BBB评分均为0分,3 d后评分(1.38 ± 0.52)分,4周后评分(11.50 ± 0.93)分,达到稳定状态,但均低于对照组(P值均<0.01).实验组大鼠脊髓损伤后3 h~6周,scMEP与BBB评分均为显著相关(r值为0.732~0.908,P值均<0.05).实验组大鼠脊髓损伤后1~6周mMEP与BBB评分呈中度至高度相关(r值为0.718~0.951,P值均<0.05).对照组大鼠以上各指标均无显著变化.结论 大鼠脊髓损伤发生后,scMEP、mMEP和BBB评分三个脊髓功能指标会先后顺序恢复,而且 scMEP、 mMEP 与 BBB 评分均存在着一定的相关性.大鼠脊髓损伤后, scMEP、mMEP是较BBB评分更为灵敏的脊髓功能评价指标.
    • 王爽; 蔡立新; 刘庆祝; 程伟科; 王文; 张茜; 姜玉武; 刘晓燕
    • 摘要: 目的 探讨应用术中感觉运动皮质的神经电生理监测指导儿童癫痫手术的可行性、有效性以及安全性.方法 连续性回顾性纳入2015年8月至2017年4月北京大学第一医院儿童癫痫中心收治的83例局灶性药物难治性癫痫患儿,均行切除性手术治疗,并予术中神经电生理监测(IOM).采用体感诱发电位确定中央沟,并直接电刺激初级运动皮质记录运动诱发电位(MEP)以定位运动功能区,之后持续行MEP监测,观察相应肌肉的复合肌肉动作电位(CMAP)的波幅变化.术后至少随访6个月.癫痫发作预后应用Engel分级评估.采用神经系统检查、Peabody运动发育量表及录像的方式,判断有无运动功能障碍.结果 80例患儿(80/83,96.4%)完成IOM.监测期间无一例出现癫痫发作及其他不良反应.行MEP监测时能引出肌肉CMAP的最小有效刺激强度为2~38 mA,中位数为20 mA.相关性分析结果显示,能引出肌肉CMAP的最小有效刺激强度与患儿手术年龄之间存在负相关关系(r=-0.302,P=0.001).80例患儿的术后无发作率为88.8%(71/80),且不同年龄和手术部位的患儿术后无发作率的差异均无统计学意义(p=0.327,P=0.475).76例CMAP波幅稳定的患儿术后未见新发的永久性运动功能损伤;4例CMAP消失的患儿中,3例出现新发的永久性运动功能损伤.术中CMAP的稳定性与患儿术后功能预后间具有一致性(P<0.001).结论 对于儿童局灶性药物难治性癫痫患者,手术中应用IOM安全、可行.儿童癫痫患者术中持续MEP监测需采用的刺激强度较高,且与年龄呈负相关.IOM可实时客观地反映癫痫患儿的运动功能状态,有助于在保护其运动功能的前提下充分切除致痫区,获得良好的预后.%Objective To investigate the feasibility,efficacy and safety of intraoperative neurophysiological monitoring (IOM) in epilepsy surgery for children.Methods A retrospective study was conducted on the clinical data of 83 children with drug-resistant epilepsy who underwent reseetive surgery and IOM at Children Epilepsy Center,Peking University First Hospital fiom August 2015 to April 2017.We used the phase reversal technique of somatosensory evoked potential to identify the central sulcus and motor evoked potential (MEP) by direct electrical stimulation of primary motor cortex to map the motor function.MEP was continuously monitored to observe the change of amplitude of compound muscle action potential (CMAP) recorded from various muscles.The seizure outcome was evaluated by Engel classification.The motor function was evaluated by the results of nerve systen examination,Peabody motor development scale and video of the patients.Results Out of 83 patients,80 (96.4%) received successful IOM.No seizures or other adverse events were observed during IOM in this series.The range of minimum effective electrical stimulation which can evoke CMAP at muscles was 2-38 mA,with the nedian of 20 mA.There was a negative correlation between this mininum effective stimulation andi age (r =-0.302,P =0.001).The rate of seizure fiee was 88.8% (71/80) in this study and there was no correlation between ages and sites of surgery (P =0.327,P =0.475).There was no new permanent motor deficit in 76 patients who demonstrated stable CMAF duuing IOM.On the other hand,3 out of 4 patients who had irreversible disappearauce of CMAP during IOM developed new permanent motor deficits post surgery.There was significant conrelation between stable CMAP and good motor outcome (P < 0.001).Conclusions IOM is safe and can be ued in children's epilepsy surgery.The electrical stimulation intensity during continuous MEP monitoring in children should be relatively elevated,and there is significant negative correlation between electrical stimulation and age.IOM could reflect the motor function in real time during surgery,and epileptogenic zone could be resected as completely as possible with good protection of motor function at the same time.The patients might have a good outcome as seizure free without new motor deficits.
    • 洪健; 韩璐; 陈步东; 姚鑫; 张雪青; 杨玉山
    • 摘要: 目的 探讨经颅电刺激面神经运动诱发电位(TCE-FNMEP)监测技术在大型听神经瘤切除术中对面神经功能的保护作用.方法 回顾性纳入天津市环湖医院神经外科2016年7月至2017年3月手术治疗的58例大型听神经瘤患者.所有患者术中行持续TCE-FNMEP联合常规肌电图监测,分别记录术前(打开硬膜)、术中及术后(缝合硬膜)TCE-FNMEP的波幅和潜伏期,分析术后与术前TCE-FNMEP波幅的比率与术后早期(术后1d)面神经功能分级(House-Brackmann分级,简称H-B分级)之间的关系.结果 58例患者中,肿瘤全切除51例(87.9%),次全切除7例(12.1%),术中面神经解剖保留率为100.0%,无死亡患者.全部患者均记录到有效的TCE-FNMEP波幅和潜伏期值.术后1d,58例患者中H-B分级Ⅰ~Ⅱ级者48例,其术后与术前TCE-FNMEP波幅的比率为47.6%~100.0%,中位数为85.4%.H-B分级Ⅲ~Ⅵ级者10例,其中H-B分级Ⅲ级者5例,术后与术前TCE-FNMEP的比率为43.2%~ 55.8%,中位数为45.4%;H-B分级Ⅳ级者3例,术后与术前TCE-FNMEP波幅的比率为31.4%~ 53.2%,中位数为33.6%;H-B分级Ⅴ~Ⅵ级者2例,术后与术前TCE-FNMEP波幅的比率分别为6.1%、11.3%.相关陛分析显示,术后与术前TCE-FNMEP波幅的比率与术后早期面神经功能分级呈负相关(r=-0.611,P<0.01).结论 TCE-FNMEP技术可以预测大型听神经瘤切除术后面神经功能分级,是一种有效的术中面神经功能保护方法.%Objective To discuss the role of transcranial electrical stimulation facial nerve motor evoked potentials (TCE-FNMEP) in resection of large acoustic neuromas.Methods In a retrospective clinical study,58 patients with large acoustic neuroma were investigated at Department of Neurosurgery,Tianjin HuanHu Hospital form July 2016 to March 2017.All patients were investigated by facial nerve motor evoked potentials elicited by multi-pulse transcranial electrical motor cortex stimulation.For recording,the same electrode set-up was used as for continuous EMG (electromyogram) monitoring of the orbicularis oculi,otis muscles and mentalis.Pre-surgical (dura opening),intraoperative and post-surgical (dura closing) TCE-FNMEP amplitudes and latencies were documened.End (dura closing) to start (dura opening) amplitude ratios were compared to early-term (1 day post surgery) facial nerve function by House-Brackmann (H-B) grading.Results Fifty-one (87.9%,51/58) patients obtained total tumor resection and 7 (12.1%,7/58) achieved subtotal resection.All patients had anatomical preservation of facial nerves.There was no death in this series.Reliable TCE-FNMEPs were obtained in all patients.At 1 day post operation,48 out of 58 case were graded as H-B Ⅰ-Ⅱ,the range of TCE-FNMEP amplitude ratio was 47.6%-100.0%,and the median was 85.4%.Five cases were graded as H-B Ⅲ,the range of TCE-FNMEP amplitude ratio was 43.2%-55.8%,and the median was 45.4%.Three cases were graded as H-B Ⅳ,the range of TCE-FNMEP amplitude ratio was 31.4%-53.2%,and the median was 33.6%.Two cases were graded as H-B Ⅴ-Ⅵ,the range of TCE-FNMEP amplitude ratio was 6.1% and 11.3%,respectively.There was a negative correlation between TCE-FNMEP amplitude ratio and early post-surgical HB grading (r =-0.611,P<0.01).Conclusion TCE-FNMEP seems to be highly reliable in predicting early postoperative facial function in resection of large acoustic neuromas and could be a valid protection technique of facial nerve.
    • 张园园; 董江涛; 张振英
    • 摘要: Objective To investigate the effect of continuous infusion of cisatracurium via an infusion pump during the maintenance phase of general anesthesia on motor-evoked potentials (MEPs) in spinal cord surgery,in order to provide an evidence for rational use of muscle relaxants for MEPs monitoring during this kind of surgery.Methods Fifty patients undergoing elective spinal cord surgery with MEPs monitoring in the First Affiliated Hospital of the Medical College,Shihezi University,from March 2015 to March 2016 were enrolled and divided into control group and experimental group according to random number table with 25 in each.The 32-Channel Cascade Elite produced by Nicolet Company in America was used to monitor MEPs in both groups.The experimental group received continuous infusion of cisatracurium via an infusion pump after the induction of general anesthesia for maintaining muscle relaxation and keeping the T1 values of TOF within 45%-55%.In the control group,intravenous injection of cisatricurium 0.15 mg/kg was given at 5 s after general anesthesia induction and no longer used during the surgery.The amplitude and latency of MEPs during the surgery and emergence from anesthesia,mean arterial pressure (MAP) and heart rate at baseline (T0),immediately after tracheal intubation (T1),at 30 minutes (T2),and 120 minutes after incision(T3),the duration of surgery,intraoperative BIS value and airway pressure,emergence time,and extubation time were recorded.Results The amplitude and latency of MEPs during emergence from anesthesia did not differ significantly between the two groups (P>0.05).During the surgery,the amplitude of MEPs was significantly lower in the experimental group than that in the control group (P0.05).The control group did not demonstrate significant changes in their amplitude and latency of MEPs during the surgery and emergence from anesthesia (P>0.05).As for the experimental group,the amplitude of MEPs during the surgery was much lower than that in emergence from anesthesia (P0.05).Administration method and duration of cisatracurium had no obvious interaction effects on MAP and heart rate (P>0.05),but each of them produced significant main effects on MAP and heart rate (P0.05).The experimental group was found with prolonged extubation time (P0.05).术中,试验组MEPs波幅较对照组降低(P0.05).对照组清醒时与术中MEPs波幅和潜伏期比较,差异均无统计学意义(P>0.05).试验组术中MEPs波幅较清醒时降低(P0.05).治疗方法与时间在MAP和心率上不存在交互作用(P>0.05);治疗方法在MAP和心率上主效应显著(P0.05);试验组患者拔管时间较对照组延长(P<0.05).两组患者均无术中知晓.结论 脊髓脊柱手术中全身麻醉维持阶段不持续静脉泵注顺式阿曲库铵对MEPs的影响小,更有利于MEPs监测.
    • 张辉; 朱詠; 严彬; 陆菡; 于布为
    • 摘要: 目的 探讨静吸复合麻醉下不同剂量右美托咪定对老年患者颈椎手术运动诱发电位(MEPs)监测及术后躁动的影响.方法 择期全麻下行颈椎手术患者60例,性别不限,年龄65~81岁,体重51~78 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为3组(n=20):对照组(C组)、低剂量右美托咪定组(D1组)和高剂量右美托咪定组(D2组).静脉注射咪达唑仑0.04 mg∕kg、顺式阿曲库铵0.15 mg∕kg、丙泊酚2 mg∕kg和舒芬太尼0.3~0.4μg∕kg诱导麻醉.麻醉诱导后采用神经电生理监测仪监测MEPs.吸入七氟醚呼气末浓度1%,靶控输注丙泊酚血浆靶浓度2~3μg∕ml维持麻醉,维持NTI值D2~E1.待T4∕T1>75% 时(T0)D1组经10 min静脉输注右美托咪定负荷剂量0.6μg∕kg,随后以0.3μg·kg-1·h-1的速率静脉输注至术毕;D2组经10 min静脉输注右美托咪定负荷剂量1μg∕kg,随后以0.3μg·kg-1·h-1的速率静脉输注至术毕;C组静脉输注等容量生理盐水.分别于T0、右美托咪定负荷剂量给药结束即刻(T1)和右美托咪定维持输注60 min(T2)记录MEPs有效引出情况、波幅和潜伏期.记录术中心血管事件和PACU期间躁动的发生情况.结果 与C组比较,D1组各时点MEPs的波幅、潜伏期和有效引出率差异无统计学意义(P>0.05),D2组T2时MEPs波幅降低,潜伏期延长,有效引出率降低,D1组和D2组术中心动过缓发生率升高,术后躁动发生率降低(P0.05).结论 静吸复合麻醉下,术中经10 min静脉输注右美托咪定负荷剂量0.6μg∕kg,随后以0.3μg·kg-1·h-1的速率静脉输注对老年患者颈椎手术MEPs监测无影响,同时可以降低术后躁动的发生率.%Objective To investigate the effects of different doses of dexmedetomidine during com-bined intravenous-inhalational anesthesia on motor evoked potentials ( MEPs) monitoring and postoperative agitation in elderly patients undergoing cervical spine surgery. Methods Sixty patients of both sexes, aged 65-81 yr, weighing 51-78 kg, of American Society of Anesthesiologists physical statusⅠorⅡ, undergo-ing elective cervical spine surgery under general anesthesia, were divided into 3 groups ( n=20 each) using a random number table method: control group ( group C) , low-dose dexmedetomidine group ( group D1 ) and high-dose dexmedetomidine group ( group D2 ) . Anesthesia was induced by intravenous injection of mid-azolam 0. 04 mg∕kg, cisatracurium 0. 15 mg∕kg, propofol 2 mg∕kg and sufentanil 0. 3-0. 4 μg∕kg. MEPs was assessed with nerve electrophysiology monitor after induction of anesthesia. Anesthesia was maintained by inhalation of sevoflurane ( end-tidal concentration 1%) and target-controlled infusion of propofol ( target plasma concentration 2-3 μg∕ml). Narcotrend index was maintained at D2-E1. When T4∕T1>75% (at T0 ) , dexmedetomidine was intravenously infused over 10 min in a loading dose of 0. 6μg∕kg, followed by an infusion of 0. 3μg·kg-1 ·h-1 until the end of surgery in group D1 . Dexmedetomidine was intravenously infused over 10 min in a loading dose of 1 μg∕kg, followed by an infusion of 0. 3 μg·kg-1 ·h-1 until the end of surgery in group D2 . The equal volume of normal saline was given intravenously in group C. At T0 , immediately after the end of administration of dexmedetomidine loading dose ( T1 ) and at 60 min of dexme-detomidine infusion ( T2 ) , the effective elicitation of MEPs and amplitude and latency of MEPs were recor-ded. The intraoperative cardiovascular events and occurrence of postoperative agitation in postanesthesia care unit were recorded. Results Compared with group C, no significant change was found in the latency, amplitude and effective elicitation rate of MEPs at each time point in group D1 ( P>0. 05) , the amplitude of MEPs was significanty decreased, the latency of MEPs was prolonged, and the elicitation rate of MEPs was decreased at T2 in group D2 , and the incidence of bradycardia during operation was significanty in-creased, and the incidence of postoperative agitation was decreased in D1 and D2 groups ( P0. 05) . Conclusion Dexmedetomidine infused over 10 min in a loading dose of 0. 6 μg∕kg, followed by an intravenous infusion of 0. 3 μg·kg-1 ·h-1 until the end of surgery during combined intravenous-inhala-tional anesthesia exerts no effect on MEPs monitoring, and can decrease the incidence of postoperative agita-tion at the same time in elderly patients undergoing cervical spine surgery.
    • 冯磊; 高景淳; 张学军; 祁新禹; 白云松; 郭东; 李浩; 曹隽; 姚子明; 高荣轩
    • 摘要: 目的 初步探讨神经电生理监测(intraoperative neurophysiological monitoring,IONM)在小儿先天性脊柱侧弯半椎体切除术中的应用价值.方法 以2017年8月至2018年7月我院134例确诊为先天性脊柱侧弯的患儿为研究对象,患儿在神经电生理监测下接受"脊柱后路椎弓根钉置入+半椎体切除+矫形术"治疗方案.术中监测指标主要包括体感诱发电位(somatosensory evoked potentials,SEP)和运动诱发电位(motor evoked potentials,MEP),置钉前获得基线.在排除线路故障、麻醉、血压下降、低体温等外界因素后,符合"基线相比SEP波幅下降50%"、"潜伏期延长10%"、"MEP波幅下降70%"中任意一条则认为达到预警判定标准.结果 134例患儿中,SEP引出率为100%,MEP引出率为97.8%,其中16例(12%)矫形过程中可见SEP波幅出现不同程度下降,但均未达到预警标准,且患儿术后无肢体感觉异常.5例(3.7%)出现MEP波幅下降,其中1例(0.7%)在置钉过程中出现一侧MEP波幅下降,4例(2.9%)在切除半椎体后矫形过程中脊柱侧弯凹侧MEP波幅逐渐下降且超过预警标准,均按要求及时放慢或停止操作,3例波幅逐渐恢复,1例波幅仍未见恢复,进行术中唤醒,证实该侧下肢肌力下降,及时调整内固定后波幅基本恢复正常.所有患儿术后均未见神经异常症状.结论 小儿先天性脊柱侧弯术中神经损伤好发于置钉、半椎体切除、矫形等关键步骤中,SEP和MEP联合监测有助于早期发现神经系统损伤,并指导术者及时停止可能造成病情恶化的操作,最大限度降低损伤程度,为改善患儿预后提供安全有效的保障.
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