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目的对比全凭静脉麻醉与静-吸复合麻醉对躯体感觉诱发电位、脑干听觉诱发电位和肌电图的影响,为脑干肿瘤手术中神经电生理监测的麻醉处理提供依据。方法择期行脑干肿瘤手术62例,随机均分为2组各31例。P组麻醉维持时泵注丙泊酚4~12mg/(kg·h),右美托咪定0.5μg/(kg·h)。I组吸入1.5%七氟醚复合丙泊酚及右美托咪定泵注,2组BIS均维持在40~50。记录麻醉前(T0)、插管后15min(T1)、手术开始时(T2)、切开脑干(T3)、切除肿瘤(T4)和术毕(T5)6个时间点的躯体感觉诱发电位、脑干听觉诱发电位和肌电图波形变化参数,并记录运动诱发电位未引出情况。结果麻醉后2组患者躯体感觉诱发电位的N20潜伏期延长、波幅降低,脑干听觉诱发电位的Ⅴ波波幅降低,潜伏期以及波间潜伏期延长;但上述指标均未达到异常标准,也未出现波形消失的情况;肌电图监测均可获得良好的肌电传导。结论与全凭静脉麻醉比较,复合1.5%七氟醚麻醉可用于行神经电生理监测的脑干肿瘤切除手术。
Objective To compare the effects of total intravenous anesthesia and intravenous anesthesia on somatosensory evoked potentials and brainstem auditory evoked potential (EMG) and electromyography (EMG), and to provide basis for the anesthesia monitoring of electrophysiological monitoring in brain stem tumors. Methods Elective brain stem tumor surgery 62 cases, were randomly divided into two groups of 31 cases. During the anesthesia in group P, propofol 4 ~ 12mg / (kg · h) and dexmedetomidine 0.5μg / (kg · h) were pumped. Group I was inhaled 1.5% sevoflurane combined with propofol and dexmedetomidine infusion, BIS in both groups were maintained at 40 to 50. The somatosensory evoked potentials were recorded at 6 time points before anesthesia (T0), 15 min after intubation (T1), the beginning of operation (T2), the incision of brain stem (T3), the removal of tumor (T4) , Brainstem auditory evoked potential and electromyogram waveform parameters, and record the motor evoked potentials did not lead to the situation. Results After anesthesia, somatosensory evoked potentials of N20 latency and amplitude were decreased, amplitude of V wave of brainstem auditory evoked potentials was decreased, incubation period and wave latency were prolonged. However, none of these indexes reached the abnormal standard nor disappeared The situation; EMG monitoring can get good myoelectricity. Conclusions Compared with total intravenous anesthesia, combined 1.5% sevoflurane anesthesia can be used in neurological electrophysiological monitoring of brain stem tumor resection.