右美托咪定在成人功能区癫痫手术清醒期的镇静作用及对癫痫灶放电次数的影响

Sedative effect of dexmedetomidine during the awake period of epilepsy surgery in adult functional area and its influence on the frequency of epileptic foci discharges

目的探讨在行脑功能区癫痫病灶切除术的成年患者术中清醒期行右美托咪定连续泵注的镇静效果及对患者癫痫灶放电次数的影响。方法选取2017年3月至2019年8月在空军军医大学第二附属医院拟行唤醒麻醉下脑功能区癫痫病灶切除术患者52例,按照入院序号奇偶性在术中清醒期分别实施不同的镇静方法,并以镇静方法作为依据将其分为丙泊酚组(奇数组)和右美托咪定组(偶数组),每组26例,比较两组患者镇静开始时(T0)、镇静10 min(T1)、镇静30 min(T2)、镇静50 min(T3)等不同时间点的改良清醒镇静评分(OAA/S)、Narcotrend指数(NI)和生命体征变化,同时采用数字脑电图机对两组患者清醒期癫痫波的变化进行观察记录。结果两组患者在镇静开始后,其NI指数较T0时刻均明显降低,差异均有统计学意义(P<0.05),但在不同时间点组间比较差异均无统计学意义(P>0.05);镇静开始后,右美托咪定组患者T1~T3的OAA/S评分分别为(4.6±1.0)分、(4.7±1.2)分、(4.8±0.9)分,明显高于丙泊酚组的(4.1±1.1)分、(3.9±0.8)分、(4.0±1.0)分,差异均具有统计学意义(P<0.05);镇静开始后,右美托咪定组患者T1~T3的心率(HR)出现显著下降,分别为(70.3±5.1)次/min、(69.8±4.2)次/min、(71.2±3.7)次/min,明显低于丙泊酚组的(80.4±4.1)次/min、(82.5±3.6)次/min、(81.7±4.3)次/min,差异均具有统计学意义(P<0.05);右美托咪定组患者T1~T3时的癫痫灶放电次数分别为(4.3±0.6)次/min、(4.5±0.4)次/min、(4.0±0.6)次/min,明显低于丙泊酚组的(6.6±0.8)次/min、(8.3±0.9)次/min、(7.1±0.9)次/min,差异均具有统计学意义(P<0.05)。结论在成人功能区开颅癫痫手术中应用右美托咪定进行唤醒手术,可在提高镇静效果的同时降低麻醉药物对癫痫波的影响,便于术中对癫痫病灶进行准确定位。

Objective To explore the sedative effect of continuous pump injection of dexmedetomidine during the awake period of adult patients undergoing epileptic foci resection in brain functional area and its influence on the frequency of epileptic foci discharges.Methods From March 2017 to August 2019,52 patients who were scheduled for epileptic foci resection under awakening anesthesia in brain functional area in the Second Affiliated Hospital of Air Force Military Medical University were selected.According to the parity of admission serial number,patients with odd serial number were assigned to receive propofol for sedation(propofol group,26 cases),and those with even serial number were assigned to receive dexmedetomidine for sedation(dexmedetomidine group,26 cases).The improved observer's assessment of alertness/sedation scale(OAA/S),Narcotrend index(NI),and vital signs changes were compared between the two groups at the start of sedation(T0),and at 10 min of sedation(T1),30 min of sedation(T2),50 min of sedation(T3).At the same time,a digital EEG machine was used to observe and record the changes of epileptic waves in the awake period in the two groups.Results The NI index at the time points during sedation(T1,T2,T3)of the two groups was significantly lower than that at T0(P<0.05),but there was no statistically significant difference between the two groups at T1,T2,T3(P>0.05).The OAA/S scores in the dexmedetomidine group were(4.6±1.0)points at T1,(4.7±1.2)points at T2,and(4.8±0.9)points at T3,which were significantly higher than(4.1±1.1)points,(3.9±0.8)points,(4.0±1.0)points in the propofol group(P<0.05).After the start of sedation,the heart rate of patients in the dexmedetomidine group(HR)decreased significantly:(70.3±5.1)times/min at T1,(69.8±4.2)times/min at T2,(71.2±3.7)times/min at T3,which was significantly lower than(80.4±4.1)times/min,(82.5±3.6)times/min,(81.7±4.3)times/min in the propofol group(P<0.05).The number of epileptic foci discharges in the dexmedetomidine group were(4.3±0.6)times/min at T1,(4.5±0.4)times/min at T2,(4.0±0.6)times/min at T3,significantly lower than(6.6±0.8)times/min,(8.3±0.9)times/min,and(7.1±0.9)times/min in the propofol group(P<0.05).Conclusion The application of dexmedetomidine for epilepsy surgery in adult functional area can improve the sedative effect and reduce the influence of anesthetics on the epileptic wave,which facilitates the accurate positioning of the epilepsy focus during the operation.