本文選題：脊柱側(cè)彎矯形術(shù) + 體感誘發(fā)電位�。� 參考：《山東大學(xué)》2014年碩士論文

【摘要】：研究背景： 隨著脊柱外科的發(fā)展,高難度的手術(shù)越來越多,術(shù)中神經(jīng)電生理監(jiān)測(cè)應(yīng)用也越來越廣泛,體感誘發(fā)電位和運(yùn)動(dòng)誘發(fā)電位因操作簡(jiǎn)單、準(zhǔn)確性高成為脊柱矯形術(shù)中脊髓神經(jīng)功能監(jiān)測(cè)最常用的方法,但圍術(shù)期不同麻醉藥或麻醉方法對(duì)其準(zhǔn)確性有一定影響。 研究目的： 探討10-15歲的青少年患者脊柱側(cè)彎矯正術(shù)中七氟醚-丙泊酚靜吸復(fù)合麻醉和丙泊酚全憑靜脈麻醉對(duì)體感誘發(fā)電位和運(yùn)動(dòng)誘發(fā)電位的影響并對(duì)兩種麻醉方法的效果進(jìn)行評(píng)估。 研究對(duì)象： 60例術(shù)中需要行脊髓功能監(jiān)測(cè)的青少年脊柱側(cè)彎患者。 研究方法： 選擇擇期行脊柱側(cè)彎矯形術(shù)的青少年患者60例,年齡10-15歲,ASA ⅠⅡ級(jí),應(yīng)用隨機(jī)分組法分成兩組：A組(丙泊酚全憑靜脈麻醉組)和B組(七氟醚-丙泊酚靜吸復(fù)合麻醉組)。兩組均采用靜脈快誘導(dǎo)麻醉,插管成功后A組以丙泊酚維持麻醉,B組吸入低于1MAC的七氟醚復(fù)合丙泊酚維持麻醉,兩組患者術(shù)中均使用舒芬太尼鎮(zhèn)痛,術(shù)中均根據(jù)腦電雙頻指數(shù)(BIS維持在45-55)調(diào)整丙泊酚輸入劑量,同時(shí)監(jiān)測(cè)誘發(fā)電位。術(shù)中記錄誘發(fā)電位波幅和潛伏期的變化及血流動(dòng)力學(xué)波動(dòng),術(shù)后觀察患者蘇醒質(zhì)量并記錄患者對(duì)麻醉手術(shù)過程是否有記憶。 研究結(jié)果： 1、兩組患者術(shù)前一般情況(年齡、體重、性別、手術(shù)時(shí)間、術(shù)中出血量等)差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)； 2、兩組患者術(shù)中血流動(dòng)力學(xué)均平穩(wěn),丙泊酚組平均動(dòng)脈壓高于七氟醚-丙泊酚組,而心率則低于七氟醚-丙泊酚組但是差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 3、與丙泊酚組相比,七氟醚-丙泊酚組誘發(fā)電位的波幅降低(P0.05)差異有統(tǒng)計(jì)學(xué)意義,而兩組患者誘發(fā)電位的潛伏期差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；兩組患者術(shù)中均可記錄到清晰可重復(fù)的誘發(fā)電位波形；兩組患者術(shù)后均沒有神經(jīng)癱瘓癥狀,對(duì)手術(shù)過程均無(wú)記憶。 4、術(shù)后七氟醚-丙泊酚組患者術(shù)后睜眼時(shí)間(10.5±6.8min)短于丙泊酚組(19.8±9.8min),拔管時(shí)間(15.9±10.5min)短于丙泊酚組(25.4±13.3min)差異有統(tǒng)計(jì)學(xué)意義(P0.05), 結(jié)論： 低于1MAC的七氟醚復(fù)合丙泊酚靜吸復(fù)合麻醉和丙泊酚全憑靜脈麻醉均可安全用于須行SEP和MEP監(jiān)測(cè)的脊柱側(cè)彎矯形術(shù)中,對(duì)誘發(fā)電位無(wú)顯著影響,而且術(shù)中血流動(dòng)力學(xué)穩(wěn)定,無(wú)術(shù)中知曉發(fā)生,是較理想的麻醉方法,尤其是七氟醚-丙泊酚靜吸復(fù)合麻醉患者蘇醒快,更利于術(shù)后神經(jīng)功能的評(píng)估。
[Abstract]:Background: With the development of spinal surgery, more and more difficult surgery, intraoperative nerve electrophysiological monitoring is also more and more widely used, somatosensory evoked potential and motor evoked potential because of simple operation. High accuracy is the most commonly used method for spinal cord nerve function monitoring in spinal orthopedic surgery, but different anesthetic or anesthetic methods in perioperative period have some influence on the accuracy of spinal cord nerve function monitoring. Objectives of the study: To investigate the effects of sevoflurane propofol combined anesthesia and propofol total intravenous anesthesia on somatosensory evoked potential and motor evoked potential during scoliosis correction in adolescents aged 10-15 years. Subjects: 60 adolescent scoliosis patients who needed spinal cord function monitoring during operation. Research methods: Sixty adolescent patients aged 10-15 years who underwent scoliosis correction were randomly divided into two groups: group A (propofol total intravenous anesthesia group) and group B (sevoflurane / propofol intravenous combined anesthesia group). Group A received propofol maintenance anesthesia group B inhaled less than 1MAC sevoflurane combined with propofol maintenance anesthesia. Sufentanil was used for analgesia in both groups. During the operation, the dose of propofol was adjusted according to the bispectral index (BIS) and the evoked potential was monitored. The amplitude and latency of evoked potential and hemodynamic fluctuation were recorded during the operation. The postoperative recovery quality was observed and the memory of the patients during anesthesia operation was recorded. Results of the study: 1. There was no significant difference between the two groups (age, weight, sex, operative time, intraoperative bleeding, etc.). The mean arterial pressure of propofol group was higher than that of sevoflurane-propofol group, but the heart rate was lower than that of sevoflurane-propofol group, but there was no significant difference between them. 3Compared with propofol group, the amplitude of evoked potential in sevoflurane and propofol group was significantly lower than that in propofol group (P 0.05). However, there was no significant difference in latency of evoked potential between the two groups (P 0.05). All the patients in the two groups recorded clear and repeatable evoked potential waveforms during operation. There were no symptoms of paralysis and no memory of the operation process in both groups. (4) the postoperative time of eye opening in sevoflurane propofol group was 10.5 鹵6.8 minutes, which was significantly shorter than that in propofol group (19.8 鹵9.8 min, 15.9 鹵10.5 min) and propofol group (25.4 鹵13.3 min). Conclusion: Sevoflurane combined with propofol combined anesthesia and total propofol intravenous anesthesia lower than 1MAC can be safely used in scoliosis orthopedics requiring SEP and MEP monitoring. There was no significant effect on evoked potential and hemodynamics was stable during operation. It is an ideal anaesthesia method, especially sevoflurane-propofol combined anesthesia, to wake up quickly and to evaluate the neurological function after operation.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614

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