咪达唑仑和丙泊酚诱导麻醉对继发性癫痫术中皮层脑电图的影响

Effects of midazolam or propofol used for induction of anesthesia on intraoperative ECoG in patients with secondary epilepsy

目的探讨咪达唑仑与丙泊酚诱导麻醉对继发性癫痫术中皮层脑电图(ECo G)的影响。方法 2013年6月至2015年9月收治非功能区占位性病变继发性癫痫180例,根据诱导麻醉方法分为咪达唑仑组(60例;0.2 mg/kg)、丙泊酚组(60例;2 mg/kg)和咪达唑仑+丙泊酚组[60例;咪达唑仑(0.05 mg/kg)+丙泊酚(1 mg/kg)]。打开硬膜后行第一次ECo G监护,病灶切除后行第二次ECo G监护。结果从麻醉诱导至第一次监护的时间为(110.3±15.9)min。第一次ECo G监护显示,咪达唑仑组暴发抑制(BS)波形发生率(68.3%,41/60)明显高于丙泊酚组(25.0%,15/60;P<0.05)和咪达唑仑+丙泊酚组(28.3%,17/60;P<0.05),后两组之间无统计学差异(P>0.05)。麻醉诱导至第一次监护时间≤120 min时,咪达唑仑组BS发生率均明显高于丙泊酚组(P<0.05)和咪达唑仑+丙泊酚组(P<0.05);>120 min时,3组BS发生率无统计学差异(P>0.05)。第二次ECo G监护显示,咪达唑仑组、丙泊酚组和咪达唑仑+丙泊酚组BS发生率分别为5.0%(3/60)、3.3%(2/60)和3.3%(2/30),3组之间无统计学差异(P>0.05)。结论继发性癫痫患者术前镇静类诱导麻醉用药宜选用小剂量咪达唑仑联合丙泊酚。

Objective To explore the option of sedating narcotics during the induction of anesthesia in patients with secondary epilepsy undergoing surgery. Methods One hundred and eighty patients with secondary epilepsy were divided into 3 groups of 60 patients each, i.e. group A in which midazolam （0.2 mg/kg） was intravenously injected, group B in which propofol （2 mg/kg） was intravenously injected and group C in which midazolam （0.05 mg/kg） and propofol （1 mg/kg） were intravenously injected before the surgery. The first electrocorticograph （ECoG 1） was detected before the resection of the lesion and the second ECoG （ECoG 2） was detected after the resection of the lesion. The rates of burst suppression （BS） occurrence during the different periods were compared among 3 groups. Results ①The BS occurrence rate （68.3%） in ECoG 1 was significantly higher in group A than those （25.0%） and （28.3%） respectively in group B and group C （P〈0.05）. ②The BS occurrence rate （74.5%,38/51） within 2 hours after the beginning of detection of ECoG 1 was significantly higher in group A than those [（28.6%, 14/49） and （31.2%, 15/48） respectively] in groups B and C （P〈0.05）. There was insignificant difference in BS occurrence rate over two hours after the beginning of detection of ECoG 1 and after the beginning of detection of ECoG 2 （P〉0.05）. Conclusions The small dose of both midazolam and propofol for the induction of anesthesia should be selected in the patients with secondary epilepsy undergoing surgery.