颅内肿瘤继发癫痫患者术中镇静药物对皮层脑电的影响

发布时间：2018-05-25 04:25

本文选题：镇静方案 + 颅内肿瘤继发癫痫　；参考：《第三军医大学学报》2015年02期

【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(P0.05);2A、C组间比较,BS发生数差异无统计学意义(P0.05);3A、D组间比较,A组BS发生数明显低于D组(P0.05);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。
[Abstract]:Objective to compare the effects of different sedation schemes on electrocorticography (ECo G) in patients with epilepsy secondary to intracranial tumors, and to explore the use of sedative drugs in epilepsy surgery. Methods from September 2012 to January 2014, 100 patients with intracranial tumors with epileptic seizures were divided into 4 groups: group A (n = 25): anesthesia induced intravenous injection of propofol (2 mg / kg), sufentanil (0.5 渭 g / kg), rocuronium (0.6 mg / kg), anesthesia for 1% sevoflurane inhalation. The concentration was controlled at 0. 80 卤0. 20) the minimum alveolar concentration was minimal alveolar concentration, combined with propofol 1. 60 ~ 2. 50 mg/(kg 路h) continuous intravenous infusion of remifentanil 1 渭 g/(kg hu, intermittent administration of propofol about 10 min before monitoring (monitoring 1) by rocuronium. The concentration of sevoflurane was controlled below 0. 5 MAC in group B: midazolam 0.1 mg/kg was injected intravenously instead of propofol, while the rest was kept pumping propofol before monitoring. The other was the same as group A and D: the concentration of sevoflurane was controlled between 0.5 and 1.0 at the time of monitoring, and the rest was the same as group A. The second ECo G monitoring was performed after lesion resection. The occurrence of burst suppressionBSs in ECo G monitoring was statistically analyzed. Results 1the incidence of BS in group A was significantly lower than that in group B (P 0.05). There was no significant difference in the incidence of BS between group C and group A; the incidence of BS in group A was significantly lower than that in group D (P 0.05); only one patient in group B had BSs. BSs were found in 12 patients with propofol intravenously during intraoperative arousal. Conclusion the recommended sedative regimen in patients with epilepsy secondary to intracranial tumors is to give propofol 2 mg / kg intravenously to induce anesthesia and maintain sedation with 1% sevoflurane inhalation combined with propofol 1.60 ~ 2.50 mg/(kg / h). Sevoflurane inhalation concentration was controlled below 0. 5 MAC during monitoring to reduce its effect on ECo G.
【作者单位】：重庆医科大学附属第一医院神经外科;重庆医科大学附属第一医院麻醉科;
【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)~~
【分类号】：R739.41;R614

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