摘要： 目的   比较七氟烷复合瑞芬太尼静脉吸入复合麻醉（吸入麻醉组）和丙泊酚复合瑞芬太尼全凭静脉麻醉（静脉麻醉组）对脊柱神经外科手术患者血糖和C-反应蛋白水平，以及术中运动诱发电位监测成功率的影响。方法   纳入患者分别以咪哒唑仑、丙泊酚、舒芬太尼、罗库溴铵进行诱导麻醉，瑞芬太尼持续静脉靶控输注维持术中镇痛；静脉麻醉组和吸入麻醉组患者分别采用丙泊酚持续静脉靶控输注和七氟烷吸入维持麻醉深度，记录围麻醉期平均动脉压、心率，观察血流动力学变化和运动诱发电位监测成功率。分别于麻醉诱导前、诱导后2 h、手术后24 h 采集患者静脉血标本，检测血糖和C-反应蛋白水平变化。结果   麻醉期间不同观察时间点，两组患者血流动力学维持稳定，静脉麻醉组平均动脉压高于吸入麻醉组（均P < 0.05）。麻醉诱导后60 和120 min，两组患者心率均低于麻醉诱导前基础值（P <0.05），其中静脉麻醉组于麻醉诱导后5 min 即开始出现心率下降，且低于吸入麻醉组（P < 0.05）。同一观察时间点（组间比较）及麻醉诱导前后（组内比较）血糖水平差异均无统计学意义（均P > 0.05）；但手术后24 h，两组患者血清C-反应蛋白水平均高于麻醉诱导前基础值（P < 0.05），且吸入麻醉组高于静脉麻醉组（P < 0.05）。静脉麻醉组患者运动诱发电位监测成功率高于吸入麻醉组（均P < 0.05）。结论   两种麻醉方法均能维持脊柱神经外科手术中血流动力学和血糖水平稳定，并抑制术中炎性应激反应，而对术后炎性应激反应无抑制作用。丙泊酚全凭静脉麻醉更适合术中运动诱发电位监测。

关键词: 麻醉, 静脉, 麻醉, 吸入, 外科手术, 脊柱疾病, 监测, 手术中, 诱发电位, 运动

Abstract: Objective To investigate the effects of sevoflurane with remifentanil (group SR) and propofol with remifentanil (group PR) on blood glucose, C-reactive protein (CRP) and achievement ratio of motor evoked potential (MEP) monitoring in patients undergoing spinal neurosurgery. Methods All patients in 2 groups were induced with midazolam, propofol, sufentanil and rocuronium bromide. Anesthesia was maintained with sevoflurane in group SR while propofol in group PR. Depth of anesthesia adaptation was according to bispectral index (BIS). Blood glucose and hemodynamics were observed at different time points. Achievement ratio of MEP monitoring was compared. Results There were no apparent fluctuations of hemodynamics in both groups. Mean arterial pressure (MAP) was higher after induction in group PR than that in group SR (P < 0.05). Heart rate (HR) in both groups were lower at 60 and 120 min after induction than baseline (P < 0.05, for all). HR was lower at 5 min after induction in group PR than that in group SR (P < 0.05). No significant difference was shown in blood glucose between 2 groups (P > 0.05). CRP level in both groups was significantly higher at 24 h after operation than that before induction (P < 0.05, for all), and it was more higher in group SR than that in group PR (P < 0.05). Achievement ratio of MEP monitoring in group PR was higher than that in group SR (P < 0.05). Conclusion Two anesthetic regimens are compatible during spinal neurosurgery, with no apparent fluctuations of perioperative blood glucose. Inflammatory response is inhibited during operation but that at postoperation. Total intravenous anesthesia with propofol is more compatible for motor evoked potential monitoring.

Key words: Anesthesia, intravenous, Anesthesia, inhalation, Surgical procedures, operative, Spinal diseases, Monitoring, intraoperative, Evoked potentials, motor