摘要：
Objective To observe the effect of intravenous anesthesia with different dosage of dexmedetomi-dine( DEX) on brain mapping and anesthesia recovery period during epilepsy resection under electrocorticography mo-nitoring. Methods Eighty obstinate epilepsy patients expected for operation were randomly divided into 4 groups:DEX groups ( group D1 ,group D2 and group D3 ) 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 D1,D2 and D3,respec-tively,which was maintained until the incision of epilepsy foci. Group NS was given 0. 9% normal saline. The anesthe-sia 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 extu-bation 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 (P0. 05 ) or between group D1 and group D2 ( P>0. 05). Compared with group NS,the incidence of severe cough and agitation in group D3 and agitation in group D2 were lower (P0. 05). Conclusion Dexmedetomidine of 0. 2,0. 3 and 0. 4 μg/(kg·h)combined with remifentanil and propofol is effective and safe in the anesthesia in epilepsy resection under electrocorticography monitoring,and the effect is best when the concentration of dexmedetomidine is 0. 3 μg/( kg·h) .%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(D1组)、右美托咪定2组(D2组)、右美托咪定3组(D3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D1组、D2组和D3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ECoG监测前,将得普利麻的靶浓度设为1.6μg/mL,ECoG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(P0.05);D3组拔管剧烈呛咳和躁动例数较NS组减少(P0.05).对照组的调整时间较DEX组延长(P0.05).结论 右美托咪定0.2、0.3、0.4μg/(kg·h)复合丙泊酚和瑞芬太尼对术中脑电监测下切除癫痫病灶手术麻醉是安全有效的,其中0.3μg/(kg·h)效果最佳.
