皮层脑电图监测下癫痫病灶切除术麻醉体会  

Anesthesia for epilepsy patients with surgical treatment under monitoring by cortical electroencephalogram

作　　者：田伟千[1] 

机构地区：[1]江苏省中医院麻醉科,210029

出　　处：《中国实用医药》2013年第27期10-11,共2页China Practical Medicine

摘　　要：目的探讨皮层脑电图监测下癫痫患者手术治疗的麻醉选择和术中管理方法。方法回顾性总结15例癫痫患者外科手术治疗的麻醉情况,采用静吸复合麻醉,全麻诱导给予芬太尼、丙泊酚、维库溴铵,以芬太尼、丙泊酚、维库溴铵静脉给予和七氟醚吸入维持麻醉。进行脑电图检查前10min减浅麻醉,待术中皮层脑电图(ECoG)病灶定位完毕再加深麻醉。术中对NBP、HR、ECG及SpO2进行连续监测。结果术中各项监测指标维持在正常范围内;颅内埋植电极和术中ECoG在单位时间内所记录到的棘波明显多于头皮脑电图,未发现麻醉后棘波活动异常增加或减少现象;出现棘波活动的痫灶与术前描记部位相一致。结论静吸复合麻醉全身麻醉是癫痫手术安全有效的麻醉方法,所使用的麻醉药及复合麻醉方法既保持了生命体征和麻醉管理的平衡,也未影响术中ECoG检测定位,合理的选择麻醉方法及药物是癫痫手术成功的保证。Objective To study the approach of anesthesia management of surgical treatment of patients with epilepsy under Monitoring by Cortical Electroencephalogram. Methods A retrospective study of 15 patients with epilepsy who, received general anesthesia during epileptic surgery, was performed. Pethidine hydrochloride and scopolamine were given as premedication. Anesthesia was induced with fentanyl , propofol and vecuronium was administered for tracheal intubation. Anesthesia was maintained with constant intravenous drip infusion of fentanyl , propofol and ecuronium , and intermittent intravenous inhalation of sevoflurane. Approximately 10 minutes before the start of intraoperative recordings of the electrocorticogram , the depth of anesthesia was reduced so that ECoG could be recorded and propofol was given in some cases in order to activate the epileptogenic focus. Depth of anesthesia returned after electrocorticogram recordings. The vital signs NBP , HR , ECG and SPO 2 were all observed. Results Vital signs of all patients were steady. All cases compared with those of preoperative electroencephalogram, the number of spike-wave recorded during unit time by endocranial embedded electrode and intraoperative ECoG increase obviously, and after the induction of anesthesia, the frequency of spike-wave did not increase or decrease . The position of the active epileptogenic focus was similar to the result of preoperative electrocorticogram detection. Conclusion Intravenous-inhalation combined anesthesia is a safe and effective method for epileptic surgery. These drugs and combined anesthetic method can not only maintain the balance of vital signs but also unaffect the position of electrocorticogram detection. Properly combined use of anesthetic agents is very important key for successful operation of epilepsy.

关 键 词：癫痫 麻醉 皮层脑电图 

分 类 号：R614[医药卫生—麻醉学]