国际麻醉学与复苏杂志   2014, Issue (10): 4-4
    
右美托咪定在脑功能区癫痫病灶切除术中的应用
高鹏, 古妙宁, 蔡铁良, 沈七襄, 张正迪, 施琼1()
1.厦门解放军第一七四医院麻醉科
The application of dexmedetomidine in the anesthesia of the brain functional epilepsy resection
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摘要:

目的 探讨右美托咪定(dexmedetomidine, Dex)在脑功能区癫痫病灶切除术中应用时,不影响脑电图及电生理监测情况的适宜剂量。 方法 美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级择期行脑功能区癫痫病灶切除术患者60例,男性34例,女性26例,年龄18岁~45岁,体重40 kg~74 kg,采用随机数字表法分为4组(每组15例):对照组(C组)、Dex 0.25 μg·kg-1·h-1组(D1组)、0.50 μg·kg-1·h-1组(D2组)和1.00 μg·kg-1·h-1组(D3组)。C组持续输注丙泊酚,其余3组于监测开始前15 min停用丙泊酚,先静脉输注Dex负荷剂量0.5 μg/kg,然后分别以0.25、0.50 μg·kg-1·h-1或1.00 μg·kg-1·h-1速率静脉输注Dex至手术结束。记录术中皮质脑电图及电生理监测的情况,脑电双频指数(bispectral index, BIS)、血压、心率变化情况,发生的副作用,丙泊酚用量以及术毕苏醒时间。 结果 与C组BIS(62±7)比较,D1组(55±4)、D2组(51±6)和D3组(44±3)的BIS值明显降低(P<0.05);C组脑电图波幅较高,夹杂的干扰波比较多,偶尔可见丙泊酚引起的突发性抑制;D3组脑电图较前3组波幅明显低平,降幅大于30%;D1和D2组的脑电图波幅适中。 结论 术中静脉输注Dex的剂量范围在0.25 μg·kg-1·h-1和0.50 μg·kg-1·h-1之间比较适合皮层脑电图及电生理监测,有利于提高脑功能区癫痫病灶切除术中定位致痫灶的准确性。

关键词: 右美托咪定;脑功能区;癫痫;静脉麻醉
Abstract:

Objective To research the appropriate dose of dexmedetomidine(Dex) in the anesthesia of the brain functional epilepsy resection, which does not affect the electroencephalogram and the electrophysiological monitoring situation. Methods Sixty patients with ASAⅠ-Ⅱ selective cerebral functional area surgery, male 34 cases, female 26 cases, ages 18 to 45 years old, 40 kg-74 kg weight. Using the random number table method, divided into four groups (n=15). The control group (group C), the Dex group intravenous injection respectively 0.25 μg·kg-1·h-1(group D1), 0.50 μg·kg-1·h-1(group D2), 1.00 μg·kg-1·h-1(group D3). Three groups of intravenous loading doses within 15 min. And then respectively with the rate 0.25, 0.50 μg·kg-1·h-1 or 1.00 μg·kg?蛳1·h?蛳1 until the end of surgery by intravenous infusion. Record the electroencephalogram and electrophysiological monitoring of the situation, the dosage of propofol, recovery times, the value of BIS, the changes of blood pressure, heart rate and the occurrence of adverse reactions intraoperative. Results Compared with group C, the BIS value of group D1, D2 and D3 had been significantly decreased(P<0.05). The ECoG amplitude of group C was higher, the inclusion of the interference wave was more, sometimes propofol caused the outbreak of the inhibition; the ECoG amplitude of group D3 was obviously lower; the ECoG amplitude of group D1 and D2 were moderate. Conclusions The adaptive dose range of the brain function lesion resection in patients with epilepsy in anesthesia appropriate ECoG and electrophysiological monitoring is 0.25 μg·kg-1·h-1 and 0.50 μg·kg-1·h-1. It is more suitable for the brain functional areas location of focal epilepsy surgery anesthesia.

Key words: Dexmedetomidine; Brain functional areas; Epilepsy; Intravenous anesthesia