熵指数指导下右美托咪定、丙泊酚及依托咪酯对脑功能区手术术中唤醒的影响

目的研究在熵指数指导下右美托咪定、丙泊酚及依托咪酯用于脑功能区手术术中唤醒的有效性及安全性。方法选择择期行脑功能区手术且需术中唤醒患者60例,随机分为右美托咪定组(D组)、丙泊酚组(P组)和依托咪酯组(E组),每组20例。手术过程中调整右美托咪定、丙泊酚或依托咪酯的泵注剂量使反应熵(RE)维持在40～60。记录唤醒时间、唤醒质量、唤醒期间不良反应的发生情况。结果 D组唤醒时间明显短于P、E两组(P0.05);D组唤醒质量明显优于P、E两组(P0.05),P组唤醒质量明显优于E组(P0.05)。D组不良反应总发生率明显低于P、E两组(P0.05)。结论在熵指数指导下,右美托咪定、丙泊酚和依托咪酯联合瑞芬太尼麻醉用于脑功能区手术术中唤醒均是安全且有效的,但右美托咪定的唤醒质量最高,唤醒期间不良反应发生率最低。

Effects of dexmedetomidine, propofol and etomidate on the intraoperative wake-up in the cerebral functional area under the guidance of entropy index

Objective To observe the efficacy and safety of dexmedetomidine, propofol and etomidate on brain functional areas in patients undergoing wake-up brain surgery under the guidance of entropy indices.
Methods Sixty patients undergoing wake-up brain surgery on brain functional areas were enrolled, randomly divided into three groups: dexmedetomidine group (group D), propofol group (group P) and etomidate group (group E), n=20 in each. During the surgery, entropy index (RE) was maintained at 40 - 60 by adjusting the dose of dexmedetomidine, propofol or etomidate. The wake-up time, wake-up quality and adverse reaction in the wake-up period were observed.
Results The wake-up time in group D was significantly less than that in groups P and E (P < 0.05), no difference between groups P and E. The wake-up quality in group D was significantly better than group P and group E (P < 0.05), group P was better than group E (P < 0.05). The incidence of adverse events in group D was lower than that in groups P and E (P < 0.05).
Conclusion Under the guidance of entropy index, the anesthesia of dexmedetomidine, propofol and etomidate combined with remifentanil can safely and effectively be used to the wake-up brain functional areas surgery, but the wake-up quality with use of dexmedetomidine is highest, and the incidence of adverse events is the lowest during wake-up period.