【摘要】：目的通過埋置于癲癇患者顱內(nèi)的微電極,動態(tài)記錄靜脈泵注丙泊酚所致的意識消失過程中皮層及皮層下腦電信號的變化,分析丙泊酚對大腦不同部位腦電活動的影響,為確定丙泊酚產(chǎn)生麻醉效應的主導位點提供依據(jù)。方法:選擇已在ROSA (robotized stereotactic assistant,機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�；颊呷胧液箝_放外周靜脈,常規(guī)監(jiān)測心率(heart rate,HR)、無創(chuàng)收縮壓(systolic blood pressure,SBP)、無創(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)),連接高導聯(lián)腦電監(jiān)測儀后開始記錄SEEG (stereoelectroencephalogram,立體定向腦電圖),記錄2分鐘,靶控輸注丙泊酚4-5ug/ml,待患者意識消失且BIS值下降到60時繼續(xù)記錄腦電信號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。結果分析腦電頻譜圖,與清醒狀態(tài)相比,麻醉狀態(tài)下各個腦區(qū)α、β、θ、δ波的能量均增高,差異有統(tǒng)計學意義(P0.05);各個腦區(qū)能量的變化差異有統(tǒng)計學意義(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。結論:靜脈輸注丙泊酚產(chǎn)生意識消失的麻醉效應時,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變化比皮層下核團更敏感。
[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.
【學位授予單位】：中國人民解放軍醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R742.1

【參考文獻】

相關期刊論文 前10條

1 王虹;蔡慧明;戴體俊;邵東華;杭黎華;;異氟烷對家兔定量藥物腦電圖δ頻段功率百分比的影響[J];華西藥學雜志;2015年01期

2 王之遙;丁曉楠;吳勁松;黎元;楊忠;車薛華;張軍;梁偉民;;全麻狀態(tài)下靜脈麻醉藥丙泊酚對大腦功能連結性的影響[J];復旦學報(醫(yī)學版);2014年02期

3 郭強;朱丹;陳俊喜;蘇菊萍;華剛;譚紅平;;機器人立體定向輔助系統(tǒng)在癲癇外科深部電極植入中的應用價值[J];立體定向和功能性神經(jīng)外科雜志;2013年05期

4 袁建虎;張曉艷;李天佐;;丙泊酚靜脈全麻致躁狂和攻擊行為1例報告[J];北京醫(yī)學;2013年08期

5 韓平平;蔡慧明;郭繼龍;吳克儉;王琦;王立偉;戴體俊;;七氟烷對兔定量藥物腦電圖δ頻段功率百分比的影響[J];中國藥理學與毒理學雜志;2012年03期

6 吳新文;顏志偉;王治中;劉思洋;趙曼麗;王珊;;全身麻醉對大鼠中樞神經(jīng)遞質的影響[J];廣東醫(yī)學;2012年10期

7 劉玲玲;王立偉;吳克儉;戴體俊;;丙泊酚對人定量藥物腦電圖δ頻段功率百分比的影響[J];徐州醫(yī)學院學報;2010年01期

8 劉玲玲;王立偉;吳克儉;戴體俊;;依托咪酯對人定量藥物腦電圖δ頻段功率百分比的影響[J];徐州醫(yī)學院學報;2009年10期

9 謝松云;張振中;楊金孝;張坤;;腦電信號的若干處理方法研究與評價[J];計算機仿真;2007年02期

10 陳斌,劉斌;全身麻醉深度監(jiān)測研究的新進展[J];國外醫(yī)學.麻醉學與復蘇分冊;2004年05期

相關碩士學位論文 前1條

1 白冬梅;腦電信號的特性分析與特征提取[D];大連理工大學;2006年

，

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