[1]王永徽,路志红,刘广林△,等.肌松程度和拮抗对经颅电刺激运动诱发电位的影响研究*[J].陕西医学杂志,2019,(12):1584-1586.
　WANG Yonghui,LU Zhihong,LIU Guanglin,et al.Effect of neuromuscular blockade and reversal on transcranial motorevoked potentials[J].,2019,(12):1584-1586.
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肌松程度和拮抗对经颅电刺激运动诱发电位的影响研究*
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2019年12期
页码:
1584-1586
栏目:
基础研究
出版日期:
2019-12-05

文章信息/Info

Title:
Effect of neuromuscular blockade and reversal on transcranial motorevoked potentials
文章编号:
DOI:10.3969/j.issn.10007377.2019.12.002
作者:
王永徽; 路志红; 刘广林△; 白晓光; 张久祥; 李 岩; 王小慧
空军军医大学西京医院麻醉科（西安 710032）
Author(s):
WANG Yonghui; LU Zhihong; LIU Guanglin; et al
Department of Anesthesiology,Xijing Hospital,Air Force Medical University(Xi’an 710032)
关键词:
动作诱发电位; 肌肉松弛药; 肌松拮抗; 神经监测; 全身麻醉; 舒更葡糖钠
Keywords:
Key words Motor evoked potential; Neuromuscular relaxant; Neuromuscular reversal; Neuromonitoring; General anesthesia; Sugammadex
分类号:
R3384
文献标志码:
A
摘要:
摘 要 目的：观察不同肌松程度和肌松拮抗对经颅电刺激运动诱发电位（TcMEPs）监测的影响。方法：选择全身麻醉下行择期神经外科手术的患者30例，进行连续肌松监测和TcMEPs监测，记录给予肌松剂前、四个成串刺激反应（Train of four，TOF）为0、1、2、3、4、25%、50%、以及给予肌松拮抗药物舒更葡糖钠后5 min，共计9个时间点的TcMEPs的波幅、潜伏期、成功率，并随访术后24 h相关不良反应。结果：TOF为0时的TcMEPs波幅显著下降，潜伏期显著延长。TOF为1～4的各时间点TcMEPs波幅较基线显著下降，但与潜伏期比较无统计学差异。给予舒更葡糖钠后5 min监测可恢复至与基线相当的水平。各时间点监测成功率均为100%，术后24 h内均未发生头皮灼伤等不良反应。结论：部分肌松对TcMEPs监测的波幅和潜伏期存在影响，舒更葡糖钠可快速恢复TcMEPs监测的可靠性。
Abstract:
Abstract Objective:Transcranial motorevoked potentials (TcMEPs) monitoring is an essential method to monitor motor pathway and avoid injury during neurosurgeryNeuromuscular relaxants may influence the efficacy of TcMEPs monitoringIn this study we observed the change of TcMEPs under neuromuscular blockade and after neuromuscular reversalMethods:In this prospective selfcontrolled clinical study,patients scheduled for elective neurosurgery under general anesthesia in Xijing hospital were enrolledNeuromuscular blockade and transcranial electrical stimulation induced TcMEPs was monitored continuouslyAmplitude,latency and success rate were recorded at 9 time points,including before neuromuscular blockade,reaction to trainoffour (TOF) stimulation=0,1,2,3,4,25%,50%,and 5 min after neuromuscular reversal by sugammadexAdverse events in 24 h after surgery were followed upResults:The amplitude was significantly lower and latency was significantly prolonged at TOF=0 than the baselineAmplitudes at TOF=14 were significantly lower than the baseline,but latencies were the sameAt 5 min after reversal by sugammadex,the amplitudes and latencies recovered to the baseline levelMonitoring waveforms were successfully achieved at all the time pointsNo adverse events including scalp burn were observed by 24 h after surgeryConclusion:Partial neuromuscular blockade may affect the amplitude and latency of TcMEPs monitoringSugammadex can recover the TcMEPs monitoring to the level of baseline

参考文献/References:

[1] 中华医学会麻醉学分会神经外科术中神经电生理监测及麻醉专家共识/中国麻醉学指南与专家共识[M]北京：人民卫生出版社，2014:5567
[2] van Dongen EP,ter Beek HT,Schepens MA,et al.Withinpatient variability of myogenic motorevoked potentials to multipulse transcranial electrical stimulation during two levels of partial neuromuscular blockade in aortic surgery[J] .Anesth Analg,1999,88:2227
[3] 李彩霞，徐振东，梁伟民不同神经肌肉阻滞程度对经颅电刺激运动诱发电位（MEPs）的影响[J] .复旦学报，2014,41(2)：234237
[4] Pechstein U,Cedzieh CTranscranial highfrequency repetitive electrical stimulation for recording myogenic motor evoked potentials with the patient under general anesthesia[J] .Neurosurgery,1996,39(2):335344
[5] 陈 旎，周守静神经肌肉阻滞程度对上肢运动诱发电位的影响[J] .中华医学杂志，2009，89（7）：445448
[6] Lieberman JA,Feiner J,Rollins M,et al.Changes in transcranial motor evoked potentials during hemorrhage are associated with increased serum propofol concentrations[J] .J Clin Monit Comput,2018,32(3):541548
[7] Sloan TB,Erian REffect of vecuroniuminduced neuromuscular blockade on cortical motor evoked potentials[J] .Anesthesiology,1993,78:966973
[8] Zafirova Z,Dalton ANeuromuscular blockers and reversal agents and their impact on anesthesia practice[J] .Best Pract Res Clin Anaesthesiol,2018,32(3):203211
[9] Pavoni V,Gianesello L,De Sciesciolo G,et al.Reversal of profound and “deep” residual rocuroniuminduced neuromuscular blockade by sugammadex:a neurophysiological study[J] .Minerva Anestesiol,2012,78(5):542549
[10] Domenech G,Kampel MA,Garcia Guzzo ME,et al.Usefulness of intraoperative neuromuscular blockade monitoring and reversal agents for postoperative residual neuromuscular blockade:a retrospective observational study[J] .BMC Anesthesiol,2019,19(1):143
[11] Honing G,Martini CH,Bom A,et al.Safety of sugammadex for reversal of neuromuscular block[J] .Expert Opin Drug Saf,2019,18(10):19
[12] Cappellini I,Ostento D,Loriga B,et al.Comparison of neostigmine vssugammadex for recovery of muscle function after neuromuscular block by means of diaphragm ultrasonography in microlaryngeal surgery:A randomised controlled trial[J] .Eur J Anaesthesiol,2019,36:\[Epub ahead of print\]
[13] Kim D,Ahn JH,Jung H,et al.Effects of neuromuscular blockade reversal on bispectral index and frontal electromyogram during steadystate desflurane anesthesia:a randomized trial[J] .Sci Rep,2019,9(1):10486
[14] 刘 骥,李正明,卜向飞,等右美托咪定在颅脑损伤患者围手术期应用[J] .陕西医学杂志,2016,45(10):14151417
[15] Scheufler KM,Reinacher PC,Blumrich W,et al.The modifying effects of stimulation pattern and propofol plasma concentration on motorevoked potentials[J] .Anesth Analg,2005,100:440447

备注/Memo

备注/Memo:
*国家自然科学基金资助项目（81871028） 空军军医大学提升计划项目（2016TSB014） 吴阶平精准肌松基金资助项目（320675018189） 陕西省科技重大专项一般项目（2018SF277）
更新日期/Last Update: 2019-12-19