右美托咪定对癫痫手术患者皮层脑电图监测的影响

Effects of dexmedetomidine on the electrocorticography monitoring in patients undergoing epilepsy surgery

目的探讨不同剂量右美托咪定对皮层脑电图(electrocorticography,ECoG)监测的影响。方法癫痫手术患者60例,随机均分为四组,其中三组术前静脉注射负荷剂量右美托咪定1μg/kg,维持剂量分别为0.2μg·kg-1·h-1(D2组)、0.4μg·kg-1·h-1(D4组)、0.6μg·kg-1·h-1(D6组),C组静脉注射等容量生理盐水。四组患者术中持续泵注瑞芬太尼及吸入七氟醚维持麻醉。记录ECoG定位时间以及术中ECoG棘波的频率、波幅及分级情况。结果 D6组ECoG定位时间明显长于C组(P<0.05)。D2、D4、D6组术中ECoG棘波的频率均低于C组,但差异无统计学意义。四组患者术中ECoG棘波波幅无明显变化。结论在癫痫病灶切除术中0.2～0.4μg·kg-1·h-1右美托咪定对ECoG棘波无明显诱发或抑制作用。

Objective To investigate the effects of dexmedetomidine on the electrocorticography （ECoG） monitoring in the different dose. Methods Sixty patients with epilepsy, were randomly divided into four groups, n = 15 for each group. A loading dose of 1μg/kg dexmedetomidine was slowly injected in group D2, D4, D6. Then the maintenance dose of dexmedetomidine was injected with speed of 0. 2μg.kg-1 .h-1 in group D2, 0. 4 μg.kg-1 -h-1 in group D4, 0.6μg.kg-1 .h-1 in group D6 respectively. The equal volume of physiological saline was injected for group C. The anesthesia was maintained with sevoflurane and remifentanil. Time from drug discontinuance to definitely electrocorticographical location, the amplitude, classification and frequency of electrocorticography waveform in operation were recorded. Results Compared with group C, the time of electrocorticography location in group D6 increased （P〈O. 05）. Classification of electrocorticography in groups D2 and D4 were very similar with group C. Compared with group C, the incidence of severe abnormality in group D6 significantly decreased （P〈0. 05）. The spike wave showed in all of four groups during electroeorticography recording. Compared with group C, the frequency of spike wave decreased in groups D2, I34 and D6, but there was no significant difference There was no significantly difference with the amplitude of spike wave in four groups. Conclusion Dexmedetomidine, injected with 0. 2-0. 4μg·kg-1·h-1 , is eligible during anesthesia in epilepsy surgery, which neither evokes nor inhibits spike wave during electrocorticography monitoring.