顽固性癫痫病人外科手术治疗的麻醉

Anesthesia for refractory epilepsy patients with surgical treatment

目的 探讨顽固性癫痫患者手术治疗的麻醉管理方法。方法 回顾性总结了 14 0例顽固性癫痫病人外科手术治疗的麻醉情况 ,术前给予咪唑安定、阿托品、东莨菪碱 ,全麻诱导给予芬太尼、异丙酚和维库溴胺 ,以芬太尼、异丙酚、维库溴铵静滴维持麻醉 ,进行脑电图检查前 30min减浅麻醉 ,某些患者辅以异丙酚 ,待术中ECoG病灶定位完毕再加深麻醉。术中对NBP、HR、ECG及SPO2 进行连续监测。结果 所有患者的生命体征平稳 ;术中ECoG描记结果与术前进行自身对照 ,证实未受明显影响。结论 全身麻醉是癫痫手术安全有效的麻醉方法 ,所使用的麻醉药及麻醉方法既保持了生命体征和麻醉管理的平衡 ,也未影响术中ECoG检测定位。合理的伍用全麻药物是癫痫手术成功的关键。

Objective To study the approach of anesthesia management of surgical treatment of patients with refractory epilepsy.Methods A retrospective study of 140 patients with refractory epilepsy who,received general anesthesia during epileptic surgery,was performed. Midazolan, atropine or scopolamine were given as premedication. Anesthesia was induced with fentanyl, propofol and vecuronium was administered for tracheal intubation.Anesthesia was maintained with constant intravenous drip infusion of fentanyl, propofol and vecuronium, and intermittent intravenous boluses of propofol and vecuronium. Approximately 30 minu before the start of intraoperative recordings of the electrocorticogram, the depth of anesthesia was reduced so that ECoG could be recorded and propofol was given in some cases in order to activate the epileptogenic focus.Depth of anesthesia returned after electrocorticogram recordings. The vital signs NBP, HR, ECG and SPO 2 were all observed.Results Vital signs of all patients were steady. All cases compared with those of preoperation the electrocorticogram recording results during operation were not affected obviously, the anesthesia management of all patients were satisfactory.Conclusions General anesthesia is a safe and effective method for epileptic surgery. These drugs and anesthetic method can not only maintain the balance of vital signs but also unaffect the position of electrocorticogram detection. Properly combined use of anesthetic agents is very important key for successful operation of refractory epilepsy.