右美托咪定在成人脑功能区癫疒间手术开颅清醒期的镇静效果观察

Observation of sedative effects of dexmedetomidine during conscious period of awake craniotomy for seizure resection in the eloquent brain areas of adults

目的：观察唤醒麻醉下行脑功能区癫疒间病灶切除术的成年难治性癫疒间病人,在术中清醒期连续泵注右美托咪定（dexmedetomidine,Dex）的镇静效果。方法拟在唤醒麻醉下行癫疒间病灶切除的成年病人48例,随机平均分为 LP、LD、MD、HD 组,术中清醒期分别泵注1.5μg/ml 丙泊酚、0.2μg/（kg·h）、0.4μg/（kg·h）和0.6μg/（kg·h）的 Dex 进行镇静。记录清醒时、开始镇静时（T0）、镇静后10 min （T1）、20 min （T2）、30 min （T3）、40 min （T4）、50 min （T5）、60 min （T6）各时间点的改良清醒镇静评分（OAA/S）、视觉模拟评分（VAS）、镇静深度指数（NI）、心率及不良事件。结果48例病人成功实施术中唤醒。镇静后Dex 各组心率明显低于 LP 组（P ＜0.05）。4组 NI 值均明显下降,镇静后各组均明显低于 T0（P ＜0.05）,T3后 HD 组显著低于其他各组（P ＜0.01）。OAA/S 在 LD、MD、LP 组随时间改变不明显,但 LP 组明显更低（P ＜0.05）。HD 组 OAA/S 始终低于 LD、MD 组,除 T1外各时间点均高于 LP 组（P ＜0.05）。LP、LD 组清醒期寒战发生率明显高于 MD、HD 组（P ＜0.05）。结论成年癫疒间病人在开颅手术清醒期使用 Dex 作为镇静药物,可提供满意的镇静效果,0.4~0.6μg/（kg·h）的剂量可明显降低寒战发生。

Objective To evaluate the sedative effects of continuous injection of dexmedetomidine （Dex） in resection of epileptogenic zone involving eloquent area in adult patients with refractory epilepsy during conscious period under awake anesthesia. Methods Forty-eight adult patients with refractory epilepsy who would accept awake craniotomy for epilepsy focus involving eloquent area were randomly and equally divided into four groups including LP group, LD group, MD group and HD group. The patients in LP group were given dose of 1.5 μg/ml propofol and patients in LD, MD and HD groups were given doses of 0.2 μg/（kg·h）, 0.4 μg/（kg·h） and 0.6 μg/（kg·h） Dex in conscious period respectively. The OAA/S, visual analogue scales （VAS）, Narcotrend index （NI）, heart rate and adverse events were recorded in different time points of conscious period, initiation of sedation （T0）, 10 min （T1）, 20 min （T2）, 30 min （T3）, 40 min （T4）, 50 min （T5） and 60 min （T6） after sedation. Results All the patients were awaken successfully during surgery. The heart rate of patients in Dex groups were significantly lower than LP group （P 〈 0.05）. The NI in all groups decreased, while NI in all the groups were significant lower after sedation than those at T0 （P 〈 0.05） and NI in HD group was lower than other groups at T3 （P 〈0.01）. The OAA/S in LD, MD and LP groups remained unchanged over time but the OAA/S in LP group decreased significantly （P 〈0.05）. The OAA/S in HD group was lower than LD and MD groups in all the time points and higher than LP group in all the time points except T1 （P 〈 0.05）. The incidence of shivering was significantly higher in LP and LD groups than MD and HD groups （P 〈0.05）. Conclusion Dex can provide good sedation effect for adult epilepsy patients during conscious period in craniotomy and decrease the incidence of shivering with the dose of 0.4 to 0.6 μg/（kg·h）.