腦功能區(qū)膠質瘤切除術麻醉喚醒方法研究

王亞峰　潘慧

摘要：目的 ?觀察在喉罩通氣下根據(jù)腦電雙頻譜指數(shù)（BIS）值指導靶控輸注調控麻醉深度，采用麻醉-喚醒-麻醉（AAA）方式施行顱內腦功能區(qū)膠質瘤切除術的安全性和有效性。方法 ?回顧性分析我院14例擬行膠質瘤切除術的腦功能區(qū)膠質瘤患者，麻醉誘導靜脈靶控輸注丙泊酚、瑞芬太尼，待患者意識消失后置入雙腔喉罩，術中根據(jù)BIS值調整血漿靶濃度，維持BIS在（45±5），待腫瘤切除后停用丙泊酚，逐漸使BIS值恢復至75以上，自主呼吸恢復后拔除喉罩，行術中喚醒，在清醒狀態(tài)下通過皮質誘發(fā)電位監(jiān)測及電刺激進行腦功能區(qū)定位和病灶切除，然后再次實施全麻，調整丙泊酚瑞芬太尼靶控輸注血漿靶濃度，使BIS值維持在（45±5）進行關顱至術畢。結果 ?14例患者均成功實施術中喚醒，有4例患者喚醒過程中出現(xiàn)血壓升高，心率增快大于30%，給予血管活血藥后維持其血流動力學穩(wěn)定;5例患者在喚醒過程中有輕微肢體活動，經(jīng)心理疏導后配合完成手術，1例患者于術中電刺激誘發(fā)癲癇發(fā)作，經(jīng)冰鹽水沖洗皮質后發(fā)作得到控制，其余4例患者生命體征平穩(wěn)，均順利完成手術。結論 ?采用BIS指導靶控輸注調控麻醉深度聯(lián)合神經(jīng)電生理監(jiān)測、術中皮質或皮質下直接電刺激技術應用于神經(jīng)外科功能區(qū)術中喚醒手術，具有較好的安全性及可操作性。

關鍵詞：腦電雙頻譜指數(shù);靶控輸注;喚醒麻醉;腦功能區(qū)

中圖分類號：R511.5 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 文獻標識碼：A ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? DOI：10.3969/j.issn.1006-1959.2020.18.029

文章編號：1006-1959（2020）18-0091-03

Study on the Method of Anesthesia and Awakening During Glioma Resection

in Functional Areas of the Brain

WANG Ya-feng，PAN Hui

（Department of Anesthesiology，Sijing Hospital，Songjiang District，Shanghai 201601，China）

Abstract：Objective ?To observe the safety and safety of target-controlled infusion to regulate the depth of anesthesia under laryngeal mask ventilation according to the EEG Bispectral index （BIS） value， and the use of anesthesia-wake-anaesthesia （AAA） to perform intracranial functional area glioma resection effectiveness.Methods ?A retrospective analysis of 14 patients with glioma in the functional area of the brain who were planned to undergo glioma resection in our hospital， anesthesia induced intravenous target-controlled infusion of propofol and remifentanil， and a double-chamber laryngeal mask was placed after the patient's consciousness disappeared during the operation， adjust the plasma target concentration according to the BIS value， maintain the BIS at （45±5）， stop propofol after the tumor is removed， and gradually restore the BIS value to more than 75， remove the laryngeal mask after the spontaneous breathing was restored， and perform the operation waking up， in the awake state， use cortical evoked potential monitoring and electrical stimulation to perform brain function area positioning and lesion resection， and then implement general anesthesia again， adjust the target-controlled plasma concentration of propofol remifentanil infusion to maintain the BIS value （45±5），the skull was closed to the end of the operation.Results ?All 14 patients were successfully awakened during the operation. In 4 patients， blood pressure increased during the awakening process， and the heart rate increased by more than 30%. After the administration of vasoactive drugs， the hemodynamic stability was maintained; 5 patients had symptoms during the awakening process. Minor physical activities， after psychological counseling， completed the operation.1 patient had a seizure induced by intraoperative electrical stimulation， and the seizure was controlled after washing the cortex with ice salt water. The remaining four patients had stable vital signs and successfully completed the operation.Conclusion ?The use of BIS to guide target-controlled infusion to control the depth of anesthesia combined with neuroelectrophysiological monitoring， intraoperative cortical or subcortical direct electrical stimulation techniques applied to intraoperative wake-up surgery in neurosurgical functional areas had good safety and operability.

Key words：EEG bispectral index;Target-controlled infusion;Wake-up anesthesia;Brain functional area

隨著神經(jīng)外科功能區(qū)手術的不斷……