颅内肿瘤继发癫痫患者术中镇静药物对皮层脑电的影响  

Effect of sedatives on electrocorticography during surgery for patients with secondary epilepsy caused by intracranial tumors

作　　者：胡铁弋[1] 但炜[1] 熊伟茗[1] 谢延风[1] 石全红[1] 詹彦[1] 王刚[1] 陆波[1] 唐晓宁[2] 

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆2400016 [2]重庆医科大学附属第一医院麻醉科,重庆400016

出　　处：《第三军医大学学报》2015年第2期150-153,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：目的比较颅内肿瘤继发癫痫患者不同镇静方案对术中皮层脑电（electrocorticography,ECo G）的影响,探讨癫痫外科手术镇静药物的用法。方法选择2012年9月至2014年1月100例伴癫痫发作的颅内肿瘤患者,分为4组,每组25例。A组：麻醉诱导静注丙泊酚（2 mg/kg）、舒芬太尼（0.5μg/kg）、罗库溴铵（0.6 mg/kg）;麻醉维持予1%七氟烷吸入,浓度控制在（0.80±0.20）最低肺泡有效浓度（minimal alveolar concentration,MAC）,复合丙泊酚1.60~2.50 mg/（kg·h）持续静脉泵入,并持续泵注瑞芬太尼1μg/（kg·h）,间断应用罗库溴铵。ECo G监测（监测1）前约10 min停泵丙泊酚,监测时将七氟烷浓度控制在0.5 MAC以下。B组：麻醉诱导静注咪达唑仑0.1 mg/kg代替丙泊酚,其余同A组;C组：ECo G监测前不停泵丙泊酚,其余同A组;D组：监测时七氟烷吸入浓度控制MAC在0.5~1.0之间,其余同A组。病灶切除后行第2次ECo G监测（监测2）,统计分析各组ECo G监测中暴发抑制（burst suppression,BS）发生数。结果 1A、B组间比较,A组BS发生数明显低于B组（P〈0.05）;2A、C组间比较,BS发生数差异无统计学意义（P〉0.05）;3A、D组间比较,A组BS发生数明显低于D组（P〈0.05）;4监测2中仅B组有1例患者出现BS,在13例术中唤醒的患者静脉推注丙泊酚时,12例（92.31%）出现了BS。结论在颅内肿瘤继发癫痫患者中推荐的镇静方案是：麻醉诱导予以丙泊酚（2 mg/kg）静脉推注,维持镇静采用1%七氟烷吸入复合丙泊酚1.60~2.50 mg/（kg·h）静脉泵入,ECo G监测前10~15 min停用丙泊酚,监测时将七氟烷吸入浓度控制在0.5 MAC之下,以减少其对ECo G的影响。Objective To compare the effect of different sedative plans on electrocorticography （EcoG） in patients with intracranial tumors, who were undergoing surgery for epilepsy, and discuss the selection of sedative plan suitable for epilepsy surgery. Methods One hundred of patients with secondary epilepsy caused by intracranial tumors from September 2012 to January 2014 were randomly divided into 4 groups （25 patients in each group）. Group A underwent anesthesia induction by intravenous injection of propofol （2 mg/kg）, sufentanil （0.5 μg/kg） and rocuronium （0.6 mg/kg）, and anesthesia maintaining by inhalation of 1% sevoflurane while controlling the concentration at 0. 80 ± 0. 20 times of minimal alveolar and intermittent application of rocuronium. Propofol was stopped about 10 min before the first ECoG monitoring （ monitoring 1 ）, and the sevoflurane concentration was controlled at MAC 〈 0.5 during monitoring.Group B underwent the same treatment as group A except that intravenous injection of midazolam （0.1 mg/kg） was used for inducing anesthesia. Group C underwent the same treatment as group A except that propofol pumping was not stopped before monitoring. Group D underwent the same treatment as group A except that the concentration of sevoflurane was controlled at 0.5 - 1.0 times of MAC during monitoring. The second ECoG monitoring （ monitoring 2） was performed after lesion resection, and the number of burst suppression （BS） in each group was statistically analyzed. Results The number of BS in group A was significantly less than that in group B, and the difference was statistically significant （ P 〈 0. 05 ）. There was no statistically significant difference in the number of BS between group A and group C （P 〉 0. 05）. The number of BS in group A was significantly less than that in group D, and the difference was statistically significant （P 〈 0. 05 ）. There was one case with BS during monitoring 2 in group B. There were 13 patients undergoing intraoperative wak

关 键 词：镇静方案 颅内肿瘤继发癫痫 暴发抑制 皮层脑电图 

分 类 号：R614[医药卫生—麻醉学] R741.044[医药卫生—外科学]