小剂量靶控输注丙泊酚在癫痫患者致痫灶切除术中研究的应用

The application of propofol target-controlled infusion during electrocorticography monitoring in epilepsysurgery

目的探讨小剂量靶控输注丙泊酚在癫癎患者致癎灶切除术术中脑电监测期间应用的可行性。方法40例行致癎灶切除术的患者，完全随机分为停用丙泊酚组（20例）和靶控输注丙泊酚组（20例）。在术中行皮质脑电图监测（ECoG）前15min，停用丙泊酚组停止注人丙泊酚，靶控输注丙泊酚组将丙泊酚靶浓度改为1mg／L。比较2组患者从改变丙泊酚输注浓度到可顺利进行ECoG期间呛咳，躁动的发生率以及术中知晓的发生率是否有差异。结果从停药到可顺利进行ECoG，停用丙泊酚组所需时间为（27±7）min，靶控输注丙泊酚组所需时间为（27±5）min，组间差异无统计学意义（P〉0．05）。靶控输液丙泊酚组脑电监测期间平均动脉压、心率、电双频谱指数均低于停用丙泊酚组[分别为（97．6±2．0）mmHg比（89．4±1．4）mmHg（1mmHg=0．133kPa），（68±10）min比（86±15）min，（65±9）比（72±9）]，差异均有统计学意义（均P〈0．05）。停用丙泊酚组患者中2例出现术中知晓，靶控输注丙泊酚组患者无术中知晓的发生。结论相对于停用丙泊酚，脑电监测期间靶控输注小剂量的丙泊酚（1mg／L）既不影响脑电监测，又可以减少术中知晓的发生率，适于致痫灶切除术中脑电监测期间麻醉管理的应用。

Objective To discuss the feasibility of small doses of target control infusion propofol during electrocorticography （ECoG）. Methods Forty patients were enrolled in this doubled -blind and prospective study. Patients were randomly divided into two groups （n = 20 each） ： target-controlled infusion （TCI） （group A） and group stopping TCI （group B）. Twenty minutes before the beginning of the ECoG ,the target plasma concentration of propofol was changed to 1 mg/L in group A and the target plasma concentration of propofol was changed to 0 mg/L in group A. The incidence rate of choke cough, restless and awareness was recorded and compared. Results The time from drug withdrawal to carrying out ECoG successfully in group A and group B had no significant difference [ （27± 7 ）min vs （27 ±5 ）min ]. There was no cough and restless in two groups. There were 2/20 cases of intraoperative awareness in group A. There was no occurrence of intraoperative awareness in group B. Conclusions During ECoG monitoring, target controlled infusion of small doses of propofol（ 1 mg/L）will not affect the ECoG monitoring and can reduce intraoperative awareness incidence. TCI of small doses of propofol （ 1 mg/L） can be used as a suitable choice for the patients undergoing epileptic foci resection.