颅内动脉瘤手术中不同剂量顺式阿曲库铵的临床应用及其对运动诱发电位的影响。
Clinical Usage of Different Doses of Cis-Atracurium in Intracranial Aneurysm Surgery and Its Effect on Motor-Evoked Potentials.
机构信息
Anesthesiology Department, The First Affiliated Hospital of Northwest University (Xi'an No. 1 Hospital), Xi'an, 710000 Shaanxi, China.
出版信息
Comput Math Methods Med. 2022 Jun 28;2022:5910019. doi: 10.1155/2022/5910019. eCollection 2022.
The objective of this work was to investigate the effect of different doses of cis-atracurium on patients undergoing general anesthesia induction (GAI) during intracranial aneurysm surgery (ICAS). In this work, 90 patients who underwent ICAS under the elective motor-evoked potential (MEP) monitoring in the First Affiliated Hospital of Northwest University (Xi'an No. 1 Hospital) from January 2021 to May 2022 were enrolled as the research objects. Randomly, they were rolled into a S1 group (30 cases, 2 times 95% effective dose (ED95) cis-atracurium), a S2 group (30 cases, 3 times ED95 cis-atracurium), and a S3 group (30 cases, 4 times ED95 cis-atracurium). The endotracheal intubation conditions, the train-of-four (TOF) rate (TOFR), body movement, and spontaneous breathing were compared among the three groups of patients. The results showed that the MEP inhibition time of the patients in the S3 group was much longer than that of the S1 and S2 groups, but it showed no significant difference between the S1 group and S2 group ( > 0.05). The good rates of endotracheal intubation conditions in the S2 group (100%) and S3 group (100%) were obviously higher than the rate in the S1 group (43.33%). The TOFRs of patients in S2 and S3 groups at time t2 and t3 were lower obviously to that at time t0, while the TOFRs of patients in S3 group at time t2 and t3 were still lower in contrast to the S2 group ( < 0.05). The mean arterial pressure (MAP) and heart rate (HR) of patients in all groups were lower at t1, t2, and t3 than at t0 ( < 0.05), while the differences among different groups were not remarkable ( > 0.05). Finally, using 3 times ED95 cis-atracurium for GAI could reduce the risk of intraoperative body movement and spontaneous breathing, as well as the residual degree of muscle relaxation, in patients with ICAS, without affecting MEP monitoring, improving endotracheal intubation conditions, and increasing safety during open neurosurgery operations.
本研究旨在探讨不同剂量顺式阿曲库铵在接受颅内动脉瘤手术（ICAS）的全身麻醉诱导（GAI）患者中的作用。本研究纳入了 2021 年 1 月至 2022 年 5 月在西北大学第一附属医院（西安第一医院）接受选择性运动诱发电位（MEP）监测的 90 例 ICAS 患者作为研究对象。随机分为 S1 组（30 例，2 倍 95%有效剂量（ED95）顺式阿曲库铵）、S2 组（30 例，3 倍 ED95 顺式阿曲库铵）和 S3 组（30 例，4 倍 ED95 顺式阿曲库铵）。比较三组患者的气管插管条件、四成串刺激（TOF）率（TOFR）、体动和自主呼吸情况。结果显示，S3 组患者的 MEP 抑制时间明显长于 S1 组和 S2 组，但 S1 组与 S2 组间差异无统计学意义（>0.05）。S2 组（100%）和 S3 组（100%）的气管插管条件良好率明显高于 S1 组（43.33%）。S2 组和 S3 组患者在 t2 和 t3 时的 TOFR 明显低于 t0 时，而 S3 组患者在 t2 和 t3 时的 TOFR 仍明显低于 S2 组（<0.05）。所有组患者的平均动脉压（MAP）和心率（HR）在 t1、t2 和 t3 时均低于 t0（<0.05），但组间差异无统计学意义（>0.05）。综上所述，对于 ICAS 患者，全身麻醉诱导时使用 3 倍 ED95 顺式阿曲库铵可降低术中体动和自主呼吸的风险，以及肌松残留程度，不影响 MEP 监测，改善气管插管条件，增加开颅神经外科手术的安全性。
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