丙泊酚对癫痫患者皮层及皮层下脑电活动的影响

发布时间：2018-11-08 13:35

【摘要】：目的通过埋置于癫痫患者颅内的微电极,动态记录静脉泵注丙泊酚所致的意识消失过程中皮层及皮层下脑电信号的变化,分析丙泊酚对大脑不同部位脑电活动的影响,为确定丙泊酚产生麻醉效应的主导位点提供依据。方法:选择已在ROSA (robotized stereotactic assistant,机器人立体定向辅助系统)定位下行电极植入后并且择期行开颅癫痫病灶切除的癫痫患者26人,患者电极植入部位为额叶,海马,岛叶,颞叶,由于手术限制,每例患者电极植入的数量和部位不同,根据电极植入的部位分为4组,分别为A组(电极植入额叶)12例;B组(电极植入海马)12例;C组(电极植入岛叶)10例;D组(电极植入颜叶)12例。其中1例患者同时在额叶、海马、,岛叶和颠叶植入了微电极,1例患者在额叶,扣带回和杏仁核植入了微电极,1例患者在扣带回和丘脑前核植入了微电极。患者入室后开放外周静脉,常规监测心率(heart rate,HR)、无创收缩压(systolic blood pressure,SBP)、无创舒张压(diastolic blood pressure,DBP)、脉搏血氧饱和度(pulse oximetry,SP02)、BIS (bispectral index,脑电双频指数),连接高导联脑电监测仪后开始记录SEEG (stereoelectroencephalogram,立体定向脑电图),记录2分钟,靶控输注丙泊酚4-5ug/ml,待患者意识消失且BIS值下降到60时继续记录脑电信号2分钟,比较不同皮层及皮层下脑电频谱的变化,包括不同波段α、β、θ、δ波的能量变化。结果分析脑电频谱图,与清醒状态相比,麻醉状态下各个脑区α、β、θ、δ波的能量均增高,差异有统计学意义(P0.05);各个脑区能量的变化差异有统计学意义(P0.05),额叶的能量变化幅度最大,而颞叶能量的变化幅度最小;麻醉后,额叶和扣带回的频谱能量高于杏仁核,扣带回的能量高于丘脑前核。结论:静脉输注丙泊酚产生意识消失的麻醉效应时,额叶、海马、岛叶、颞叶的频谱能量变化较为明显,其中额叶变化最大,颞叶的变化最小;麻醉后,大脑皮层的脑电信号变化比皮层下核团更敏感。
[Abstract]:Objective to dynamically record the changes of cortical and subcortical EEG in the process of consciousness disappearance induced by intravenous infusion of propofol, and analyze the effect of propofol on brain electrical activity in different parts of the brain. It provides the basis for determining the dominant site of propofol to produce anesthetic effect. Methods: a total of 26 epileptic patients who had been placed in the ROSA (robotized stereotactic assistant, robot stereotactic assistant system (ROSA (robotized stereotactic assistant,) were selected. The electrodes were implanted in frontal lobe, hippocampus, island lobe and temporal lobe of 26 epileptic patients after selective craniotomy. Due to the limitation of operation, the number and location of electrode implantation were different in each patient. According to the site of electrode implantation, the patients were divided into 4 groups, 12 patients in group A (electrode implanted into frontal lobe). There were 12 cases in group B (electrode implanted into hippocampus), 10 cases in group C (electrode implanted into insular lobe) and 12 cases in group D (implanted into facial lobe). Microelectrodes were implanted in frontal lobe, hippocampus, insular lobe and apical lobe in 1 case, microelectrode in frontal lobe, cingulate gyrus and amygdala in 1 case, and microelectrode in cingulate gyrus and anterior thalamic nucleus in 1 case. After entering the room, peripheral veins were opened, heart rate (heart rate,HR), noninvasive systolic blood pressure (systolic blood pressure,SBP), noninvasive diastolic blood pressure (diastolic blood pressure,DBP), pulse blood oxygen saturation (pulse oximetry,SP02), BIS (bispectral index,) were monitored routinely. The SEEG (stereoelectroencephalogram, stereotactic EEG was recorded after connecting the high-lead EEG monitor) and recorded for 2 minutes. Target controlled infusion of propofol 4-5ugrml. The EEG signals were recorded for 2 minutes when the consciousness disappeared and the BIS value decreased to 60. The changes of the spectrum of EEG in different cortical and subcortical regions were compared, including the energy changes of 伪, 尾, 胃, 未 waves in different bands. Results compared with awake state, the energy of 伪, 尾, 胃, 未 waves in each brain region increased under anesthesia, and the difference was statistically significant (P0.05). The difference of energy in each brain area was statistically significant (P0.05), the change amplitude of energy in frontal lobe was the largest, and that in temporal lobe was the smallest. After anesthesia, the spectral energy of frontal lobe and cingulate gyrus was higher than that of amygdala, and the energy of cingulate gyrus was higher than that of prethalamic nucleus. Conclusion: when intravenous infusion of propofol produces anaesthetic effect of loss of consciousness, the changes of spectral energy in frontal lobe, hippocampus, island lobe and temporal lobe are more obvious, especially in frontal lobe and temporal lobe. After anesthesia, EEG changes in the cerebral cortex were more sensitive than those in the subcortical nucleus.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.1

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