额肌自发肌电的临床价值是.doc

PAGE   PAGE 9 额肌自发肌电的临床价值 康荣 邓丽云 赵嘉训 摘要: 目的 探讨A-Line麻醉深度监测仪中非诱发EMG的监测功能是否可以指导临床工作中肌松药物的应用。方法 应用麻醉深度监测仪和肌松监测仪在整个麻醉期间对30例全麻和15例连硬外麻醉的患者监测AAI、EMG、TOF的值，重点观察各个时期指标的变化；并且应用统计学来分析它们之间的相关性及差异性。结果 在15例连硬外麻醉的患者中表明EMG与AAI有很好的相关性。30例全麻的患者在各个时期EMG与AAI、TOF均有一定相关性。结论 A-Line无创麻醉深度监测仪中EMG受到镇静和肌松的双重影响。 关键词：听觉诱发电位，肌松，麻醉深度 Abstract Objective To determine whether auto-EMG can be used clinically as an index during the application of muscle relaxants or not. Methods Values of AAI, EMG, TOF were measured during the whole period of anesthesia by monitoring of the depth of anesthesia and neuromuscular function in 30 cases undergoing general anesthesia and 15 cases given continuous epidural anesthesia. The changes of these indexes were specially observed during each period of anesthesia. Statistics was used to analyze the correlation and difference between these indexes. Results In 15 cases given continuous epidural anesthesia, there was good correlation between EMG and AAI. In 30 cases undergoing general anesthesia, there was some correlation between EMG, AAI and TOF during each period of anesthesia. Conclusion EMG in A-Line noninvasive monitor of depth of anesthesia is influenced by both sedation and muscle relaxation. Key Words auditory evoked potentials, muscle relaxation, depth of anesthesia 1研究对象与方法 1.1.研究对象： 本实验研究了45例择期手术患者，ASAⅠ～Ⅱ级，其中30例为全麻，15例为连硬外麻醉。合并有肝病、肾病、血液系统疾病、过度肥胖（超过理想体重20﹪）或过度消瘦（低于理想体重20﹪）、服用影响肝功或肝血流的药物或以往有全麻不良反应者不予入选本试验。 1.2麻醉方法： 1.2.1连硬外麻醉患者入室后常规穿刺、置管、给药，麻醉平面出现后连接A-Line麻醉深度监测仪，静注吗啡5mg，氟哌利多2.5mg，咪唑安定0.04~0.06 mg/kg。2%利多卡因维持麻醉，每30min 追加5ml。 1.2.2全麻患者麻醉前静注吗啡5mg，氟哌利多2.5mg，东莨菪碱0.3mg作为术前用药。麻醉诱导用芬太尼3～4ug/kg、维库溴铵0.08～0.1mg/kg、异丙酚1.5-2 mg/kg，经口明视气管插管，接Drager-Fabius 麻醉呼吸机。麻醉维持2%普鲁卡因持续静脉定量输注辅助异氟烷吸入，间断静注维库溴铵，根据患者生命体征调整麻醉用药。 1.3监测方法： 1.3.1麻醉深度监测 用丹麦Danmeter公司生产的A-Line麻醉意识深度监测仪判断麻醉深度。使用过程中要注意清洁皮肤，仔细选择电极的位置，并且要接地线，另立电源，尽量避免各种干扰，这样可以得到最佳数据。 1.3.2肌松监测 采用Organon公司生产的TOF-Watch SX加速度肌松监测仪进行肌松监测，刺激腕部尺神经，刺激方式为TOF，电刺激脉宽200μs，频率2Hz，电流50mA，间隔时间12s。监测拇内收肌的肌颤搐反应。 1.4记录指标： 1.4.1连硬外麻醉