无肌松药条件下气管插管后即刻监测运动诱发电位基线在腰椎手术中的应用

doi:10.3969/j.issn.1006-5725.2024.16.016

摘要/Abstract

摘要：

目的探讨腰椎手术在无肌松药气管插管后即刻监测运动诱发电位（TceMEP）基线的可行性。方法将2023年5-12月在徐州市中心医院拟行经椎间孔入路腰椎椎体间融合术（TLIF）的患者156例随机分为两组，最终对照组72例，男33例，女39例，观察组75例，男37例，女38例，对照组在术中脊柱暴露完成后监测TceMEP基线，观察组在无肌松药气管插管后即刻监测TceMEP基线。对比两组患者气管插管前后血流动力学变化、插管满意度和操作时间，并比较两组TceMEP基线引出成功率、刺激阈值、敏感性和特异性。结果两组患者气管插管时血流动力学变化与插管满意度差异无统计学意义（P > 0.05），插管时间对照组为（6.52 ± 1.22）min，观察组为（9.44 ± 0.84）min，两组差异有统计学意义（P < 0.05）。观察组TceMEP基线引出成功率为100%，平均刺激阈值（225.00 ± 22.13）V，对照组TceMEP基线引出成功率为84.72%，平均刺激阈值（342.01 ± 31.07）V，两组差异有统计学意义（P < 0.05）。对照组在上钉后监测TceMEP成功率为93.06%，观察组为100%，两组差异有统计学意义（P < 0.05）。两组TceMEP的敏感度和特异度差异无统计学意义（P > 0.05）。结论无肌松气管插管后即刻监测TceMEP基线成功率高，刺激阈值小，敏感性与特异性与术中脊柱暴露完成后监测TceMEP基线无差别。

关键词: 运动诱发电位基线, 术中神经电生理监测, 无肌松药气管插管, 腰椎手术

Abstract:

Objective To investigate the feasibility of monitoring the baseline of motor evoked potentials immediately following tracheal intubation without the administration of muscle relaxants in lumbar spine surgery. Methods A prospective study was conducted at Xuzhou Central Hospital， involving a total of 156 patients who were scheduled for Transforaminal Lumbar Interbody Fusion. These patients were randomly divided into two groups： a control group consisting of 72 cases （33 males and 39 females） and an observation group consisting of 75 cases （37 males and 38 females）. The control group underwent monitoring of motor evoked potentials （TceMEP） baseline after spinal exposure during the operation， while the observation group had immediate monitoring of TceMEP baseline after tracheal intubation without muscle relaxants. Hemodynamic changes， intubation satisfaction， and operation time during tracheal intubation were compared between the two patient groups. Additionally， the baseline success rate， stimulation threshold， sensitivity， and specificity of TceMEP were compared between the two groups. Results There were no significant differences in hemodynamic changes and intubation satisfaction between the two patient groups during tracheal intubation （P > 0.05）. The control group had an intubation time of （6.52 ± 1.22） min， while the observation group had a significantly longer intubation time of （9.44 ± 0.84） min （P < 0.05）. The baseline success rate of TceMEP in the observation group was 100%， with an average stimulation threshold of （225.00 ± 22.13）. In contrast， the control group had a baseline success rate of 84.72% and an average stimulation threshold of （342.01 ± 31.07）V for TceMEP monitoring prior to nailing procedures. The success rate of monitoring TceMEP after nailing in the control group was 93.06%， whereas it reached 100% in the observation group， demonstrating a statistically significant difference between the two groups （P<0.05）. There were no statistically significant differences in sensitivity and specificity between the two groups for TceMEP monitoring results（P>0.05）. Conclusions The success rate of monitoring TceMEP baseline immediately after tracheal intubation without muscle relaxation is higher， with a smaller stimulation threshold. There were no differences in sensitivity and specificity compared to the baseline monitoring of TceMEP after spinal exposure during the operation.

Key words: baseline of motor evoked potentials, intraoperative neurophysiological monitoring, tracheal intubation without muscle relaxants, lumbar spine surgery

中图分类号:

B841.1

郑伟,李娜,刘磊,刘松涛,周海,刘杰,胡正权,王立伟. 无肌松药条件下气管插管后即刻监测运动诱发电位基线在腰椎手术中的应用[J]. 实用医学杂志, 2024, 40(16): 2298-2304.

Wei ZHENG,Na LI,Lei LIU,Songtao LIU,Hai ZHOU,Jie LIU,Zhengquan HU,Liwei. WANG. Feasibility of monitoring the baseline of motor evoked potentials immediately after tracheal intubation without muscle relaxants in lumbar spine surgery[J]. The Journal of Practical Medicine, 2024, 40(16): 2298-2304.

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项目	对照组（n = 72）	观察组（n = 75）	t/χ²值	P值
性别（例）			0.180	0.671
男	33（45.8）	37（49.3）
女	39（54.2）	38（50.7）
年龄（x ± s，岁）	54.7 ± 4.6	57.2 ± 5.6	3.727	0.531
BMI（x ± s，kg/m²）	26.4 ± 4.9	25.2 ± 4.3	0.961	0.329
腰椎疾病类型			1.020	0.797
腰椎间盘突出	25（34.8）	29（38.7）
腰椎管狭窄	23（31.9）	22（29.3）
腰椎间盘突出伴椎管狭窄	15（20.8）	12（16.0）
腰椎滑脱伴椎管狭窄	9（12.5）	12（16.0）
手术间隙			0.273	0.601
单间隙	48（66.7）	53（70.7）
≥ 2间隙	24（33.3）	22（29.3）

组别	评分
组别	1	2	3	4
下颌松弛	完全	轻度张力	紧	僵硬
喉镜暴露	容易	一般	困难	不能置入
声带位置	张开	颤动	关闭	紧闭
呛咳	无	轻微	中等	严重
体动反应	无	轻微	中等	严重

	组别	T₀	T₁	T₂	T₃	F值	P值
MAP（mmHg）	对照组（n = 72）	87.40 ± 5.52	80.01 ± 4.83^?	82.81 ± 5.33	86.33 ± 5.52^#	29.180	< 0.001
MAP（mmHg）	观察组（n = 75）	87.08 ± 6.58	80.56 ± 4.00^?	83.12 ± 6.02	85.71 ± 5.07^#	20.590	< 0.001
HR（次/min）	对照组（n = 72）	73.92 ± 9.74	63.78 ± 6.54^?	66.19 ± 8.85	73.44 ± 10.17^#	23.632	< 0.001
HR（次/min）	观察组（n = 75）	72.37 ± 9.63	62.71 ± 7.10^?	65.23 ± 9.69	71.95 ± 9.33^#	25.611	< 0.001
SpO₂（%）	对照组（n = 72）	98.01 ± 1.27	99.87 ± 0.34	99.92 ± 0.31	98.96 ± 0.90	91.548	< 0.001
SpO₂（%）	观察组（n = 75）	97.95 ± 1.43	99.82 ± 0.39	99.91 ± 0.58	99.01 ± 1.11	65.9693	< 0.001

组别	声音嘶哑	咽部疼痛	牙龈损伤	黏膜损伤
对照组（n = 72）	2（2.78）	5（6.94）	1（1.39）	3（4.17）
观察组（n = 75）	4（5.33）	15（18.7）	2（2.67）	4（5.33）
χ²值	0.613	4.485	0.300	0.110
P值	0.434	0.034	0.584	0.740

组别	上钉后	减压后	植骨融合后	神经探查后
对照组	67（93.06）	72（100）	72（100）	72（100）
观察组	75（100）	75（100）	75（100）	75（100）
χ²值	5.39
P值	0.02