丙泊酚对癫痫发作患者致痫灶激化作用的研究  

Intensification of propofol on epileptogenic focus in patients with epilepsy

作　　者：熊伟茗[1] 但炜[1] 王超[1] 胡铁弋[1] 谢延风[1] 石全红[1] 

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400016

出　　处：《第三军医大学学报》2013年第15期1570-1573,共4页Journal of Third Military Medical University

基　　金：重庆市卫生局重点课题(2012-1-008);国家临床重点专科建设项目([2011]170号)~~

摘　　要：目的观察静脉推注丙泊酚对皮层脑电图(electrocorticography,ECoG)波形的影响,探究其对幕上肿瘤伴癫痫患者致痫灶脑电活动的激化作用。方法选择2011年4月至2012年2月我院神经外科60例幕上肿瘤伴癫痫发作患者为试验组,不伴癫痫发作的无皮质侵犯的深部肿瘤及动脉瘤患者40例为对照组。所有患者行常规静吸复合麻醉,硬脑膜切开后,停用丙泊酚10～15 min,最低肺泡有效浓度(minimum alveolar concentration,MAC)控制在0.3～0.4,脑电双频指数(bispectral index,BIS)控制在40～60,于术区行ECoG监测,于癫痫波明显处做标记,待脑电背景恢复后推注丙泊酚(0.1 mg/kg),以丙泊酚推注前2 min(时段A)与推注后至暴发抑制现象前(时段B)之间为自身对照比较的2个时间段,定量、定性比较各组ECoG癫痫波的变化。病灶切除后,术中麻醉重复上述过程,对试验组非功能区致痫灶行皮层切除或热凝癫痫波(处理组),对功能区致痫灶暂不处理(非处理组)。术后随访20～24个月,比较术后早期癫痫发生率、晚期癫痫控制率。结果①硬脑膜切开后,试验组推注丙泊酚前后(时段A与B)棘波定量分析:棘波波幅分别为(347±30)、(479±27)μV,波幅增长幅度为1.2～1.6倍;棘波频率分别为(31±6)、(44±7)Hz,频率增加1.0～2.0倍;经配对t检验,差异有统计学意义(P<0.05)。对照组棘波量化分析无统计学差异(P>0.05)。试验组与对照组棘波定性比较:静推丙泊酚后,试验组棘波增强率为95.00%(57/60),对照组仅为10.00%(4/40),两组差异有统计学意义(χ2=72.89,P<0.05)。②随访结果:处理组术后早期癫痫发作5例(13.89%,5/36),非处理组术后早期癫痫发作9例(42.86%,9/21)。差异有统计学意义(χ2=6.01,P<0.05)。晚期癫痫控制率:处理组与非处理组分别为88.89%(EngelⅠ～Ⅱ级,32/36)及61.90%(EngelⅠ～Ⅱ级,13/21),差异有统计学意义(χ2=4.30,P<0.05)。结论小剂量静推丙泊酚对幕上肿瘤伴癫痫发作�Objective To explore the intensification of propofol on electrical activity of epileptogenic focus of the secondary epilepsy in patients with supratentorial tumor by observing the effect of intravenous injection（iv） of propofol on the wave of electrocorticography（ECoG）.Methods Patients with supratentorial tumors complicated with seizures were enrolled as a treatment group（n = 60）,and patients with deep tumors or aneurysm but no seizures were enrolled as a control group（n = 40）.All the patients underwent conventional inhalation anesthesia.After cerebral dura mater had been incised,the administration of propofol was stopped for 10-15 min to control minimum alveolar concentration（MAC） within 0.3-0.4 and bispectral index（BIS） within 40-60.ECoG monitoring was performed in the surgical area,and the site with prominent epileptic wave was marked.After the EEG background recovered,propofol（0.1 mg / kg） was injected.The changes of ECoG epileptic wave were quantitatively and qualitatively compared between the 2 groups in 2 min before injection of propofol（period A） and the burst of suppression（period B）.After lesions had been incised,the anesthesia repeated the above processes.The treatment group was divided into a T group（epileptogenic focus in the nonfunctional areas） and a non-T group（epileptogenic focus in the functional areas）.For the patients of the T group,the treatment was repeated until the residual epileptic waves disappeared,while for those of the non-T group,no treatment was carried out.The patients were followed up for 20-24 months to compare the incidenceof early postoperative epilepsy and the rate of seizure free.Result ① After incision of cerebral dura mater,the quantitative analysis of spike in period A and period B： The average volatility of spike was 347 ± 30 and 479 ± 27 mV in period A and period B,and the growth rate of volatility was about 1.20-1.60 times.The average frequency of spike was 31 ± 6 and 44 ± 7 Hz in period A and period B,and the growth r

关 键 词：丙泊酚 皮层脑电图 幕上肿瘤 继发性癫痫 激化 

分 类 号：R741.044[医药卫生—神经病学与精神病学] R742.1[医药卫生—临床医学]