异丙酚浓度变化对术中体感和运动诱发电位监测的影响

Effect of propofol dose changes on intraoperative somatosensory and motor evoked potentials monitoring

中文关键词:  静脉麻醉  异丙酚  体感诱发电位  运动诱发电位  术中监测  脊柱侧凸

英文关键词:Intravenous anaesthesia  Propofol  Somatosensory evoked potential  Motor evoked potential  Intraoperative monitoring  Scoliosis surgery

中文摘要:

  【摘要】 目的：探讨异丙酚浓度变化对体感诱发电位（SEP）和运动诱发电位（MEP）的影响。方法：20例接受手术治疗的特发性脊柱侧凸患者，术中实施异丙酚静脉全麻和多模态神经电生理监护。在麻醉诱导期间，观察SEP、MEP随异丙酚浓度增加的变化。在矫形操作完成后的伤口缝合过程中，观察SEP、MEP随麻醉浓度降低的变化。分别记录相应异丙酚剂量增加和剂量减少后电位达到平台期的延迟时间。结果：异丙酚浓度的变化不会引起SEP和MEP潜伏期的显著变化（SEP：36.1±2.6ms vs 36.2±2.3ms，P＞0.05；MEP：27.0±1.5ms vs 27.1±1.6ms，P＞0.05）。异丙酚浓度的增加可以显著降低SEP波幅值（1.91±0.53μV vs 1.37±0.55μV，P＜0.001）和MEP幅值（175.7±134μV vs 127±81μV，P<0.001）；异丙酚浓度降低则显著增加SEP幅值（1.26±0.64μV vs 1.50±0.56μV，P＜0.005）和MEP幅值（143±100μV vs 169±133μV，P＜0.005）。SEP、MEP的变化相对于异丙酚剂量变化存在滞后效应。当剂量增加时，延迟期显示SEP为18.5±6.5min，而MEP为10.5±3.6min；当剂量减少时，延迟期显示SEP为29.6±10.6min，而MEP为13.5±6.3min，两组间比较差异有显著统计学意义（P<0.05）。结论：异丙酚剂量升高可造成SEP和MEP幅值的快速下降，剂量降低可使其峰值增加；MEP较SEP对异丙酚剂量变化更为敏感。

英文摘要:

  【Abstract】 Objectives: To investigate the effect of propofol dose changes on somatosensory evoked potential(SEP) and motor evoked potential(MEP). Methods: Twenty patients with idiopathic scoliosis received surgical treatment with propofol intravenous anaesthesia, and multimodality intraoperative neurophysiologic monitoring was reviewed. The changes of SEP and MEP in responding to dose increase were recorded during induction of anaesthesia, and the changes in responding to dose decrease were recorded during closure procedure. Dose-increase delay and dose-decrease delay periods were measured accordingly. Results: The change of propofol dose did not produce significant change in latency of SEP (36.1±2.6ms vs 36.2±2.3ms, P>0.05) and MEP (27.0±1.5ms vs 27.1±1.6ms, P>0.05). The increase of propofol dose significantly decreased the amplitude of SEP (1.91±0.53μV vs 1.37±0.55μV, P<0.001) and MEP (175.7±134μV vs 127±81μV, P<0.001), while the decrease of propofol dose significantly increased the amplitude of SEP (1.26±0.64μV vs 1.50±0.56μV, P<0.005) and MEP (143±100μV vs 169±133μV, P<0.005). However, there was lag effect of SEP and MEP changes in responding to dose change of propofol. The dose-increase delay period was 18.5±6.5min in SEP and 10.5±3.6min in MEP respectively, while dose-decrease delay period was 29.6±10.6min in SEP and 13.5±6.3min in MEP respectively, there were statistically differences between two groups(P<0.05). Conclusions: The dose of propofol increase may produce a faster decrease of SEP and MEP. On the contrary, the dose decrease will cause a increase of SEP and MEP. In addition, MEP is more sensitive to dose changes of anesthetic than SEP.