【摘要】：目的通過(guò)埋置于癲癇患者顱內(nèi)的微電極,動(dòng)態(tài)記錄靜脈泵注丙泊酚所致的意識(shí)消失過(guò)程中皮層及皮層下腦電信號(hào)的變化,分析丙泊酚對(duì)大腦不同部位腦電活動(dòng)的影響,為確定丙泊酚產(chǎn)生麻醉效應(yīng)的主導(dǎo)位點(diǎn)提供依據(jù)。方法:選擇已在ROSA (robotized stereotactic assistant,機(jī)器人立體定向輔助系統(tǒng))定位下行電極植入后并且擇期行開(kāi)顱癲癇病灶切除的癲癇患者26人,患者電極植入部位為額葉,海馬,島葉,顳葉,由于手術(shù)限制,每例患者電極植入的數(shù)量和部位不同,根據(jù)電極植入的部位分為4組,分別為A組(電極植入額葉)12例;B組(電極植入海馬)12例;C組(電極植入島葉)10例;D組(電極植入顏葉)12例。其中1例患者同時(shí)在額葉、海馬、,島葉和顛葉植入了微電極,1例患者在額葉,扣帶回和杏仁核植入了微電極,1例患者在扣帶回和丘腦前核植入了微電極。患者入室后開(kāi)放外周靜脈,常規(guī)監(jiān)測(cè)心率(heart rate,HR)、無(wú)創(chuàng)收縮壓(systolic blood pressure,SBP)、無(wú)創(chuàng)舒張壓(diastolic blood pressure,DBP)、脈搏血氧飽和度(pulse oximetry,SP02)、BIS (bispectral index,腦電雙頻指數(shù)),連接高導(dǎo)聯(lián)腦電監(jiān)測(cè)儀后開(kāi)始記錄SEEG (stereoelectroencephalogram,立體定向腦電圖),記錄2分鐘,靶控輸注丙泊酚4-5ug/ml,待患者意識(shí)消失且BIS值下降到60時(shí)繼續(xù)記錄腦電信號(hào)2分鐘,比較不同皮層及皮層下腦電頻譜的變化,包括不同波段α、β、θ、δ波的能量變化。結(jié)果分析腦電頻譜圖,與清醒狀態(tài)相比,麻醉狀態(tài)下各個(gè)腦區(qū)α、β、θ、δ波的能量均增高,差異有統(tǒng)計(jì)學(xué)意義(P0.05);各個(gè)腦區(qū)能量的變化差異有統(tǒng)計(jì)學(xué)意義(P0.05),額葉的能量變化幅度最大,而顳葉能量的變化幅度最小;麻醉后,額葉和扣帶回的頻譜能量高于杏仁核,扣帶回的能量高于丘腦前核。結(jié)論:靜脈輸注丙泊酚產(chǎn)生意識(shí)消失的麻醉效應(yīng)時(shí),額葉、海馬、島葉、顳葉的頻譜能量變化較為明顯,其中額葉變化最大,顳葉的變化最小;麻醉后,大腦皮層的腦電信號(hào)變化比皮層下核團(tuán)更敏感。
[Abstract]:Objective to dynamically record the changes of cortical and subcortical EEG in the process of consciousness disappearance induced by intravenous infusion of propofol, and analyze the effect of propofol on brain electrical activity in different parts of the brain. It provides the basis for determining the dominant site of propofol to produce anesthetic effect. Methods: a total of 26 epileptic patients who had been placed in the ROSA (robotized stereotactic assistant, robot stereotactic assistant system (ROSA (robotized stereotactic assistant,) were selected. The electrodes were implanted in frontal lobe, hippocampus, island lobe and temporal lobe of 26 epileptic patients after selective craniotomy. Due to the limitation of operation, the number and location of electrode implantation were different in each patient. According to the site of electrode implantation, the patients were divided into 4 groups, 12 patients in group A (electrode implanted into frontal lobe). There were 12 cases in group B (electrode implanted into hippocampus), 10 cases in group C (electrode implanted into insular lobe) and 12 cases in group D (implanted into facial lobe). Microelectrodes were implanted in frontal lobe, hippocampus, insular lobe and apical lobe in 1 case, microelectrode in frontal lobe, cingulate gyrus and amygdala in 1 case, and microelectrode in cingulate gyrus and anterior thalamic nucleus in 1 case. After entering the room, peripheral veins were opened, heart rate (heart rate,HR), noninvasive systolic blood pressure (systolic blood pressure,SBP), noninvasive diastolic blood pressure (diastolic blood pressure,DBP), pulse blood oxygen saturation (pulse oximetry,SP02), BIS (bispectral index,) were monitored routinely. The SEEG (stereoelectroencephalogram, stereotactic EEG was recorded after connecting the high-lead EEG monitor) and recorded for 2 minutes. Target controlled infusion of propofol 4-5ugrml. The EEG signals were recorded for 2 minutes when the consciousness disappeared and the BIS value decreased to 60. The changes of the spectrum of EEG in different cortical and subcortical regions were compared, including the energy changes of 偽, 尾, 胃, 未 waves in different bands. Results compared with awake state, the energy of 偽, 尾, 胃, 未 waves in each brain region increased under anesthesia, and the difference was statistically significant (P0.05). The difference of energy in each brain area was statistically significant (P0.05), the change amplitude of energy in frontal lobe was the largest, and that in temporal lobe was the smallest. After anesthesia, the spectral energy of frontal lobe and cingulate gyrus was higher than that of amygdala, and the energy of cingulate gyrus was higher than that of prethalamic nucleus. Conclusion: when intravenous infusion of propofol produces anaesthetic effect of loss of consciousness, the changes of spectral energy in frontal lobe, hippocampus, island lobe and temporal lobe are more obvious, especially in frontal lobe and temporal lobe. After anesthesia, EEG changes in the cerebral cortex were more sensitive than those in the subcortical nucleus.
【學(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R742.1

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