不同剂量丙泊酚颈内动脉注射进行Wada试验的效果对比

Comparison of effects on different doses of propofol for intracarotid injections in Wada test

目的探讨不同剂量的丙泊酚颈内动脉注射对语言及记忆功能优势半球测试的影响,对比不良反应的发生情况。方法对40例难治性癫痫患者采用颈内动脉注射丙泊酚进行Wada试验,根据所采用剂量不同分为10 mg和7 mg两组。对比两组不同剂量颈内动脉注射组的语言、记忆功能测试情况,计算注药后半球失活的持续时间,并观察不良反应的发生情况。同时收集患者的年龄、病程、全量表智商等相关数据,分析两不同剂量组的差异。结果所有患者均完成了语言优势半球测试,28例患者完成了记忆优势半球的测试。两组在年龄、病程、全量表智商方面的差异无统计学意义(均P>0.05);注药后左侧半球和右侧半球的失活时间,两组之间的差异均无统计学意义(均P>0.05)。两组患者记忆优势半球的测试成功率分别为56%和93%,差异有统计学意义(P=0.03)。两组均有发生Ⅰ、Ⅱ级的不良反应,但7 mg组未出现Ⅲ级不良反应,两组不良反应发生率的差异有统计学意义(P=0.01)。结论采用丙泊酚7 mg的剂量进行颈内动脉注射,可顺利完成语言优势半球的测试,提高记忆功能测试的成功率,减少不良反应的发生,是一个值得推荐的剂量。

Objetive To explore the usefulness of different doses of propofol as a anesthetic agent for language and memory test in patients with refractory epilepsy,and discuss the incidence rate of adverse effects of intracarotid propofol injection during the Wada test. Methods A series of40 patients underwent intracarotid propofol Wada tests. According to propofol doses,the patients were divided into two groups,which were 10 mg-group and 7 mg-group respectively. The patients＇ age,course of disease,Full-scale IQ,the accomplishment ratios of language and memory testing,the hemisphere inactivated duration,and the adverse effects of propofol were calculated respectively. The variability of these two different doses groups were evaluated. Results The hemispheric language dominance was established in all patients. Memory dominance tests were completed in 28 patients.There were no significant differences in patients＇ age,course of disease and Full-scale IQ between the two groups（ all P 0. 05）. After intracarotid propofol injection,there were no significant differences between the two groups in the hemisphere inactivated duration,mean duration（ all P〉0. 05）. The accomplishment ratios of memory testing between two groups were 56% vs. 93%,the differences was significant（ P = 0. 03）. The Grade Ⅰ and Ⅱ adverse effects of propofol were happened in two groups,but no Grade Ⅲ adverse effects were found in 7 mg-group. The frequency of adverse effects of propofol were more higher in 10 mg-group than 7 mg-group（ P = 0. 01）. Conclusions With 7 mg doses of propofol for intracarotid injection in Wada test,we could determine the lateralization of the language dominance successfully,increased the accomplishment ratios of memory testing,decreased the frequency of adverse effects. It was advisable to recommend this dose for intracarotid propofol injection in Wada test.