术中唤醒麻醉下语言区肿瘤切除术的临床研究

摘要

目的 探讨全身麻醉术中唤醒方法行语言区肿瘤切除术的安全性和可行性.方法 选择位于大脑语言区肿瘤患者9例,麻醉前一天用焦虑自评量表(SAS)测定患者焦虑状况.对患者进行喉罩通气,罗哌卡因头皮浸润麻醉,丙泊酚和瑞芬太尼靶控输注,间断静脉推注舒芬太尼.术中唤醒后行语言功能监测(指认图片、连续计数),并行唤醒后的警觉/镇静评分(OAA/S)、视觉模拟评分(VAS),再行神经电生理刺激,确定语言区和切除范围.术后随访3个月.结果 8例患者麻醉前SAS评分为(45.6±1.7)分,唤醒后OAA/S为(4.8±0.2)分,VAS为(0.7±0.3)分,镇痛完善,完全配合术者要求进行语言功能监测和神经电生理定位语言区.1例患者麻醉前SAS评分为62分,唤醒后OAA/S为2.5分,VAS为8.0分,因唤醒后术中出现癫痫持续发作,放弃唤醒.随访3个月,8例患者功能完全恢复正常,1例存在轻度语言功能障碍.结论 在唤醒麻醉下行语言功能监测及神经电生理定位有助于最大程度地切除语言区病灶,提高患者术后生存质量.%Objective To discuss the safety and feasibility for resection of tumors in eloquent cortex under wake -up during general anesthesia.Methods A total of 9 cases with tumors in eloquent cortex were selected and the anxiety statuses of the patients were evaluated consulting the Self - Rating Anxiety Scale (SAS) at the day before the operations.Scalp ropivaeaine infiltrating anesthesia was used and ventilation by LMA.The certain depth of anesthesia was kept by target controlled infusion of propofol plus remifentanil compounding sufentanil discontinuous infusion.The patients'language function were monitored (by pictures identifying and continuous number counting), and to proceed Observer3 Assessment of Alertness/Sedation Scale (OAA/S) and Visual Analogue Scale ( VAS), and stimulated by neuro - electrophysiological to confirm linguistic area and their scope after the patients were woke - up during the operations.Patients were postoperatively followed - up 3 months.Results There were 8 patients whose SAS were (45.6 ± 1.7) before they received anesthesia and OAA/S were (4.8 ± 0.2) and VAS were (0.7 ± 0.3 ) after wake - up.It fulfilled the patients' request to monitor the language function and locate language area by neuroeleetrophysiologieal monitoring.1 patient's SAS was 62 before anesthesia and the OAA/S was 2.5 and VAS was 8.0 after wake - up.We gave up to keeping on wake - up because epilepsy sustained attacked during the operation after wake - up.The functions of the 8 patients were completely back to normal and the other 1 who had mild speech difficulties during 3 months'follow- up after operation.Conclusion Language function monitoring and neuroelectrophysiological location can be helpful for resection of lesions in eloquent cortex safely under wake - up anesthesia and it can improve the life quality in patients.