不同麻醉方法在致痫灶精确定位切除术中应用的比较

目的对癫痫手术患者麻醉管理进行回顾性比较,探讨致痫灶精确定位切除手术中较好的麻醉方法。方法对2005年至2007年间,首都医科大学宣武医院127例癫痫手术的麻醉病例资料进行回顾与分析。所有患者根据麻醉方法分为全麻组(A组,105例),全麻+术中唤醒组(B组,16例)和局麻+安定镇痛组(C组,6例)。A组和B组均实施全麻插管,患者插管后持续输注丙泊酚(2.69±0.48)mg/(kg.h-1),瑞芬太尼(0.09±0.02)μg/(kg.min-1)和维库溴胺0.05～0.06 mg/(kg.h-1)维持麻醉,其中部分A组患者联合吸入异氟烷0.4%～0.6%,而B组患者均未吸入异氟烷;C组患者不实施全麻,在用0.5%利多卡因与0.25%罗哌卡因合剂行头皮神经阻滞后,经静脉输注丙泊酚1～2 mg/(kg.h-1)和瑞芬太尼0.03～0.05μg/(kg.min-1)实施安定镇痛。结果所有患者均在致痫灶定位术实施前15 min停止丙泊酚和维库溴铵输注。在15～30 min 94.8%的A组患者均可满意实施致痫灶定位的检测;而B组患者在停药后20～40 min 100%可成功唤醒患者并实施检测;C组患者停药后清醒较快,但对致痫灶定位操作的耐受较差,其中2例患者拒绝合作而放弃。结论静脉麻醉和静吸复合全麻均适合于癫痫手术的麻醉管理,术中应严格掌握给药剂量与时机,根据手术步骤精确调节麻醉药物的输注以获得满意的麻醉效果。

Individualized Anesthesia for Epileptogenic Foci Resection by Precise Localization

Objective To explore individualized anesthesia management for patients undergoing epileptogenic foci resection and decrease the effects of narcotics and anesthetic management on electrocorticography(ECoG) monitoring during epilepsy surgery and to study the awake testing during general anesthesia(GA) and anesthesia management for electrophysiological stimulation of cortex during the operation.Methods The data of 127 patients undergoing epilepsy surgery from 2005-2007 were reviewed and analyzed.The patients w...