轻度镇静对幕上占位病人神经功能的影响与头部磁共振表现的相关因素分析

Effects of mild sedation on neurologic function in patients with supratentorial mass lesion and the associated factors in head magnetic resonance imaging

目的本研究通过分析幕上占位病人头部磁共振表现,发现不同镇静药诱发神经缺陷的病人存在的危险因素。方法该研究为前瞻性、随机、单盲对照研究。符合纳入标准的病人采用数字表法随机分配至异丙酚组、咪达唑仑组、芬太尼组或右美托咪啶组。每组病人均使用相应镇静药物滴定至清醒镇静评分(Observer’s Assessment of Alertness and Sedation,OAA/S)4分,给予镇静药物之前和之后进行美国国立卫生院卒中评分(National Institutes of Health Stroke Scale,NIHSS),并在评估过程结束后详细记录头部核磁结果。结果本研究发现不同机制的镇静药物在轻度镇静的情况下对于幕上肿瘤的病人神经功能缺陷有着暴露或恶化的作用。病变位于运动区(P=0.000)、感觉区(P=0.004)、累及基底节(P=0.031)和发生中线移位(P=0.000)、脑室扩张或压缩(P=0.000)、瘤周水肿时(P=0.000)的肿瘤更容易引起镇静相关的神经功能缺陷。结论头部磁共振显示为运动区和中线移位的病人神经功能改变对轻度镇静更敏感。但是对于镇静药物对脑功能影响的机制还有待于进一步探讨。

Objective Sedation may induce or exacerbate neurologic function in some patients with supratentorial mass lesion.This trial aimed to investigate the risk factor of sedative associated neurologic deficits in that population through analyzing head magnetic resonance imaging （MRI）.Methods The study was a prospective,randomized,single-blind,controlled trial.Patients were randomly assigned to one of the four study groups,including ＇Propofol group＇,＇Midazolam group＇,＇Fentanyl group＇ or ＇Dexmedetomidine group＇.In each group,patients were titrated to Observers Assessment of Alertness and Sedation （OAA/S） score 4 with a ladder-like administration of the assigned drug to target this same sedation level.National Institutes of Health Stroke Scale （NIHSS） was applied to evaluate before and after the sedation.Patients magnetic resonance imaging （MRI） findings were collected after the evaluation.Results This study showed that mild sedation unmasked or exacerbated neurologic deficits in patients with supratentorial brain tumors.Patients with brain tumors in the primary motor area（P=0.000）,primary sensory area（P=0.004）,basil ganglion（P=0.031）,with brain midline shift（P=0.000）,brain ventricular compression or expansion（P=0.000） as well as present peritumor edema（P〈0.001）had a higher probability of sedative related neurologic deficits.Conclusion The neurologic function altering is more sensitive to sedation if MRI displays a primary motor area mass lesion and brain midline shift.However the potential mechanism of sedative related neurologic deficits is still in need of further investigation.