不同剂量右美托咪定在癫痫病灶切除术中的临床研究  

Clinical study on different dosage of dexmedetomidine in the anesthetic management of epilepsy resection under electrocorticography monitoring

作　　者：沈洁[1] 纪永[2] 金秋 吴辉辉[4] 

机构地区：[1]中国医科大学附属盛京医院麻醉科,沈阳110004 [2]济宁市第一人民医院,山东济宁272011 [3]抚顺市石化总医院,辽宁抚顺113006 [4]上海市第一人民医院,上海201600

出　　处：《实用药物与临床》2017年第2期167-171,共5页Practical Pharmacy and Clinical Remedies

基　　金：辽宁省科学技术项目(2013225049)

摘　　要：目的观察不同剂量右美托咪定(Dexmedetomidine,DEX)在皮层脑电图监测下行癫痫病灶切除术中对脑功能区域定位及麻醉苏醒期的影响,旨在探讨用于癫痫外科手术麻醉的适宜的右美托咪定剂量。方法选择因顽固性癫痫择期开颅行病灶切除术的80例患者,随机均分4组,分别为右美托咪定1组(D_1组)、右美托咪定2组(D_2组)、右美托咪定3组(D_3组)和生理盐水对照组(NS组)。DEX组麻醉诱导前均输注负荷量右美托咪定0.4μg/kg,之后D_1组、D_2组和D_3组分别持续泵注右美托咪定0.2、0.3、0.4μg/(kg·h),直至病灶切除硬脑膜缝合结束,NS组给予等量生理盐水。四组患者均给予舒芬太尼、得普利麻和罗库溴胺全麻诱导,得普利麻靶控输注2.0~2.5μg/mL,瑞芬太尼3~6μg/(kg·h)静脉输注,顺苯磺阿曲库胺0.5 mg/kg单次静脉注射维持麻醉,切开硬脑膜时停止瑞芬太尼输注,行ECo G监测前,将得普利麻的靶浓度设为1.6μg/mL,ECo G监测完成后各药物恢复之前维持剂量。手术结束后,停用所有药物,待患者自主呼吸恢复、拔除气管导管、生命体征平稳后送入麻醉恢复室。记录气管插管、切皮、拔管等各时间点的MAP、HR、苏醒时间、拔管时间及围术期不良反应例数;记录调整时间及爆发抑制发生例数,选择基线稳定、无干扰的10 s描记图为统计对象,计算各脑电波形的频率和波幅。结果插管即刻和拔管时,DEX组HR低于NS组(P<0.05);手术结束拔除气管导管时,DEX组MAP低于NS组(P<0.05)。D_3组患者苏醒时间、拔管时间较NS组、D_1组和D_2组延长(P<0.05),D_1组、D_2组与NS组比较、D_1组与D_2组比较,差异均无统计学意义(P>0.05);D_3组拔管剧烈呛咳和躁动例数较NS组减少(P<0.05),D_2组患者躁动例数较NS组减少(P<0.05),各组均未发生呼吸抑制和术中知晓。术中ECo G监测显示,各组患者棘波频率和波幅比较差异无统计学意义(P>0.05)。对照组的调整时间较DEObjective To observe the effect of intravenous anesthesia with different dosage of dexmedetomidine（DEX） on brain mapping and anesthesia recovery period during epilepsy resection under electrocorticography monitoring.Methods Eighty obstinate epilepsy patients expected for operation were randomly divided into 4 groups：DEX groups（group D_1 group D_2 and group D_3） and control group（group NS）.In DEX groups,a loading dose of 0.4 μg/kg DEX was slowly injected within 10 min followed by 0.2,0.3 and 0.4 μg/（kg·h） DEX for D_1,D_2 and D_3,respectively,which was maintained until the incision of epilepsy foci.Group NS was given 0.9%normal saline.The anesthesia was induced with sufentanyl,propofol and rocuronium and maintained with target controlled infusion（TCI） of propofol 2.0~2.5 μg/mL,remifentanil 3~6 μg/（kg·h） and cisatracurium 0.5 mg/kg.Remifentanil was stopped when the dura mater was cut,and the target concentration of propofol was set at 1.6 μg/mL before electrocorticogram（ECoG） was monitored.All the concentrations of drugs were recovered after ECoG was monitored.All the drugs were stopped after operation,and the patients were sent to the awake room when the life sign was stable.The MAP and HR were continuously recorded at the time points of intubation,skin incision and extubation.The awake time,time of extubation and the number of adverse reactions were recorded.The 10 s scanning maps without interference were chosen to calculate the frequency and amplitude of spine by electrophysiology experts.The time of location of epilepsy loci and the number of burst suppression were recorded.Results Compared with group NS,the HR in group DEX was lower（P〈0.05） at the time points of intubation and extubation,and the MAP was lower at extubation（P〈0.05）.The awake time and extubation time in group D_3 was longer than those of the other groups（P〈 0.05）.There was no significant difference between group D_1（or group D_2） and group NS（P0.05） or between group D_1 and group D_2

关 键 词：右美托咪定 癫痫 皮层脑电图 全凭静脉麻醉 

分 类 号：R614[医药卫生—麻醉学]