摘要
目的为术中正中神经体感诱发电位监测选择合适的监测指标和全麻药浓度。方法ASAⅠ～Ⅱ级行气管插管全麻病人28例,随机分为异丙酚(P)组和异氟醚(I)组。P组静脉输注异丙酚,使病人依次出现指令反应消失、呼吸停止后行气管插管。I组在气管内插管后吸入异氟醚并使肺泡内异氟醚浓度依次达0.5MAC、1.0MAC、1.5MAC。记录两组诱导前及上述各时点的HR、PetCO2、NT、MAP、SpO2、MnSSEP;P组同时测定异丙酚血药浓度。结果随着异丙酚、异氟醚浓度的增高,皮层下诱发电位N13'变化最小;皮层体感诱发电位的潜伏期延长、波幅降低,其中以N20、P25最稳定,在较高浓度才受麻醉药影响。结论当用异丙酚和异氟醚施行全麻时,N13'最适于作为脊髓脊柱手术的监测指标;N20、P25适于脑部手术监测。异丙酚血药浓度低于2.51μg·ml-1,异氟醚低于1.0MAC时对其无影响。
Objective To choose suitable monitoring index and general anesthetic blood concentration for median nerve somatosensory evoked potential(MnSSEP)during operation. Methods 28 patients with ASA grade Ⅰ to grade Ⅱ were randomly divided into two groups:group P and group I. In the group P, the propofol was used intravenously.When the patient happened disappearence of instructive reaction and apnea in turn,the tracheal intubation was performed.In the group I,after tracheal intubation,isoflurane was inhaled and isoflurane concentrations of intraalveoli were reached to 0.5 MAC,1.0 MAC and 1.5 MAC in turn.HR,PetCO2,NT,MAP,SPO2 and Mn SSEP were recorded in the two groups.The blood concentrations of propofol were determined in the group P at the same time.Results With blood concentrations of propofal and isoflurane were increased,the change of N13′ evoked potentials of subcortex was minimum.The latency of cortical somatosensory evoked potentials(CSEP)was prolonged.The amplitudes of wave were decreased.Among them,N20,P25 were most stable,but it could be effected by anesthetics in the more high concentrations.Conclusion When the propofol and isoflurane are used for general anesthesia,N13′ as monitoring index of spinal cord or spiral column operation is best choice.N20,P25 is suitable for monitoring of cerebral operations.When the propofol blood concentrations are lower than that 2.51μg·ml-1 or isoflurane are lower than that 1.0 MAC,the monitoring of CSEP will not be influenced.
出处
《岭南现代临床外科》
2004年第4期292-294,303,共4页
Lingnan Modern Clinics in Surgery
