【摘要】：研究目的:以上肢運(yùn)動(dòng)誘發(fā)電位(MEP)的潛伏期和波幅變化為指標(biāo)，采用序貫法定量測(cè)定吸入麻醉藥七氟醚和異氟醚使上肢運(yùn)動(dòng)誘發(fā)電位(MEP)成功監(jiān)測(cè)的ED50值，及其95%的可信區(qū)間。 方法:隨機(jī)選擇ASAI～I(xiàn)I級(jí)，擬行全麻下行擇期顱腦手術(shù)患者37例，年齡45~65歲，隨機(jī)分為兩組：七氟醚組（I組：n=18）；異氟醚組（II組：n=19）。兩組在麻醉誘導(dǎo)前均靜脈注射咪達(dá)唑侖0.05mg/kg。 I組患者按序貫法吸入七氟醚，初始濃度設(shè)為2.8％，系列濃度為2.8％、2.4％、2.0％，間隔為0.4%。每種預(yù)設(shè)呼氣末濃度各維持15min，觀察患者上肢拇短展肌的運(yùn)動(dòng)誘發(fā)電位的波形。若患者15min內(nèi)波形消失，將監(jiān)測(cè)結(jié)果，定為陽(yáng)性（＋），，則下一例患者所用七氟醚的濃度，就降低一個(gè)濃度間隔;反之，若病人15min內(nèi)波形未消失，將監(jiān)測(cè)結(jié)果，定為陰性（－），則下一例患者所用七氟醚的濃度就增加一個(gè)濃度間隔。當(dāng)出現(xiàn)6個(gè)由（＋）至（－）的交叉點(diǎn)(cross·over)時(shí)，終止本組實(shí)驗(yàn)。 II組患者按序貫法吸入異氟醚，誘導(dǎo)方式相同，但初始濃度設(shè)為2.0％，系列濃度為2.0％、1.6％、1.2％，間隔亦為0.4%。同樣觀察運(yùn)動(dòng)誘發(fā)電位的波形，當(dāng)出現(xiàn)6個(gè)由（＋）至（－）的交叉點(diǎn)(cross·over)時(shí)，終止本組實(shí)驗(yàn)。每隔5min，記錄病人平均動(dòng)脈壓（MAP）、心率（HR）及脈搏氧飽和度（SpO2）和呼氣末二氧化碳分壓（ETCO2），分別計(jì)算七氟醚和異氟醚使上肢MEP監(jiān)測(cè)成功的ED50，及其95％的可信區(qū)間。 結(jié)果:（1）I組七氟醚的ED50為2.35%（1.39MAC），其95％的可信區(qū)間為2.21％~2.50 ％（1.31MAC~1.47MAC）； （2）II組異氟醚的ED50為1.59％（1.38MAC），其95％的可信區(qū)間為1.50％~1.67％（1.30MAC-1.45MAC）。 （3）當(dāng)七氟醚呼氣末濃度為2.0%時(shí)，上肢運(yùn)動(dòng)誘發(fā)電位（MEP）監(jiān)測(cè)成功率為100%；呼氣末濃度為2.4%時(shí)，上肢運(yùn)動(dòng)誘發(fā)電位（MEP）監(jiān)測(cè)成功率為33%；呼氣末濃度為2.8%時(shí)，上肢運(yùn)動(dòng)誘發(fā)電位（MEP）監(jiān)測(cè)成功率為0。 （4）當(dāng)異氟醚呼氣末濃度為1.2%時(shí)，上肢運(yùn)動(dòng)誘發(fā)電位（MEP）監(jiān)測(cè)成功率為100%；呼氣末濃度為1.6%時(shí)，上肢運(yùn)動(dòng)誘發(fā)電位（MEP）監(jiān)測(cè)成功率為44%；呼氣末濃度為2.0%時(shí)，上肢運(yùn)動(dòng)誘發(fā)電位（MEP）監(jiān)測(cè)成功率為0。 結(jié)論: 實(shí)行上肢運(yùn)動(dòng)誘發(fā)電位（MEP）監(jiān)測(cè)時(shí)， （1）單獨(dú)應(yīng)用七氟醚麻醉時(shí)，使上肢運(yùn)動(dòng)誘發(fā)電位監(jiān)測(cè)成功的ED50是2.35％（1.39MAC），其95％的可信區(qū)間為2.21％-2.50％（1.31MAC-1.47MAC）； （2）單獨(dú)應(yīng)用異氟醚麻醉時(shí)，使上肢運(yùn)動(dòng)誘發(fā)電位監(jiān)測(cè)成功ED501.59％（1.38MAC），其95％的可信區(qū)間為1.50％-1.67％（1.30MAC-1.45MAC）； （3）七氟醚能抑制上肢運(yùn)動(dòng)誘發(fā)電位（MEP）的產(chǎn)生，對(duì)誘發(fā)電位的影響呈劑量依賴(lài)性； （4）異氟醚能抑制上肢運(yùn)動(dòng)誘發(fā)電位（MEP）的產(chǎn)生，對(duì)誘發(fā)電位的影響呈劑量依賴(lài)性。
[Abstract]:Objective: to determine the ED50 values of the upper limb motor evoked potential (MEP) successfully monitored by sevoflurane and isoflurane by sequential quantitative method with the change of latency and amplitude of upper limb motor evoked potential (MEP). And its 95% confidence interval. Methods: 37 patients, aged 45 to 65, were randomly divided into two groups: sevoflurane group (group I: n = 18) and isoflurane group (group II: n = 19). Before anesthesia induction, midazolam was injected intravenously with 0.05 mg / kg midazolam in both groups. In group I, sevoflurane was inhaled sequentially, the initial concentration was 2.8, and the serial concentration was 2.82.42.0.The interval was 0.4. Each preset end-expiratory concentration was maintained for 15 min, and the waveform of motor evoked potential of abductor pollicis brevis muscle was observed. If the waveform disappeared in the patient's 15min and the monitoring result was positive (+), the concentration of sevoflurane used in the next patient was reduced by one concentration interval. On the other hand, if the waveform in the patient's 15min does not disappear, the monitoring results are negative (-), then the concentration of sevoflurane used in the next patient increases by a concentration interval. When there were 6 cross points (+) to (-) (cross over), the experiment was terminated. In the II group, isoflurane was inhaled in the same way, but the initial concentration was 2.0 and the serial concentration was 2.01.2.The interval was 0.450. The waveform of motor evoked potential was also observed. When there were 6 crossing points (+) to (-), the experiment was terminated. The mean arterial pressure (MAP), pulse oxygen saturation (SpO2) and end expiratory carbon dioxide partial pressure (ETCO2) were recorded every 5 min. The ED50, of sevoflurane and isoflurane for MEP monitoring of upper extremity were calculated, respectively. And its 95% confidence interval. Results: (1) in group I, the ED50 of sevoflurane was 2.35% (1.39MAC), and its 95% confidence interval was 2.21% (1.31MAC~1.47MAC). (2) the ED50 of isoflurane in II group was 1.59% (1.38MAC), and its 95% confidence interval was 1.50% 1.67% (1.30MAC-1.45MAC). (3) when the end-expiratory concentration of sevoflurane was 2.0, the success rate of (MEP) monitoring of upper limb motor evoked potential was 100, and the success rate of (MEP) monitoring of upper limb motor evoked potential was 33 when the end expiratory concentration was 2.4. When the end expiratory concentration was 2.8, the success rate of (MEP) monitoring of upper limb motor evoked potential was 0. 0. (4) when the end-expiratory concentration of isoflurane was 1.2, the success rate of (MEP) monitoring of upper limb motor evoked potential was 100, and the success rate of (MEP) monitoring of upper limb motor evoked potential was 44 when the end expiratory concentration was 1.6. The success rate of (MEP) monitoring of motor evoked potential in upper extremity was 0. 0 when the end expiratory concentration was 2. 0. Conclusion: when the upper limb motor evoked potential (MEP) was monitored by (MEP), (1) when sevoflurane was used alone, the ED50 of the upper limb motor evoked potential monitoring was 2.35% (1.39MAC). The 95% confidence interval was 2.21- 2.50% (1.31MAC-1.47MAC). (2) when isoflurane was used alone, the upper limb motor evoked potential (1.38MAC) was monitored successfully with 95% confidence interval of 1.50- 1.67% (1.30MAC-1.45MAC); (3) sevoflurane could inhibit the production of (MEP) in upper limb motor evoked potential in a dose-dependent manner. (4) Isoflurane could inhibit the production of (MEP) in upper limb motor evoked potential in a dose-dependent manner.
【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R614.4

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