摘要
目的研究丙泊酚复合瑞芬太尼全麻对立体定向手术机器人(ROSA)辅助丘脑底核(subthalamic nucleus,STN脑深部电刺激术(deep brain stimulation,DBS)术中微电极记录(microelectrode recording,MER)信号与手术效果的影响。方法分析40例行ROSA-STN-DBS的帕金森病(Parkinson’s disease,PD)病例资料,随机分为研究组(n=20)和对照组(n=20)。通过调整术中丙泊酚用量,研究组在脑电双频指数(bispectral index,BIS)值40~60之间进行一侧MER;在BIS值>70时进行另一侧MER。对照组MER均在局麻清醒状态下进行。结果靶点神经元细胞放电的最大振幅,研究组明显小于对照组(P <0.05)。两组定位误差和术后统一帕金森病评定量表(unified Parkinson’s disease rating scale,UPDRS)评分无显著性差异。研究组组内比较,靶点神经元细胞放电最大振幅,低BIS组明显小于高BIS组(P <0.05),其余观察指标无统计学差异。结论丙泊酚复合瑞芬太尼全麻下MER信号存在不同程度减弱,但不影响STN特征性信号识别。丙泊酚复合瑞芬太尼全麻对术中电极精确定位和手术效果无影响,可安全应用于ROSA-STN-DBS。
Objective To study the effect of general anesthesia with propofol and remifentanil on the microelectrode recording(MER) signal and the outcome of stereotactic surgical robot(ROSA) subthalamic nucleus(STN) deep brain stimulation(DBS).Methods The data of 40 Parkinson’s disease(PD) patients undergoing ROSA-STN-DBS were analyzed and randomly divided into study group(n = 20) and control group(n = 20). By adjusting the intraoperative propofol dosage, the research group underwent MER on one side between the bispectral index(BIS) values of 40-60;when the BIS value was >70, MER was performed on the other side. MER in the control group was performed under local anesthesia. Results The maximum amplitude of discharge of target neuron cells was significantly smaller in the study group than in the control group(P < 0.05). There was no significant difference in the positioning error and the unified Parkinson’s disease rating scale(UPDRS) between the two groups. Intragroup comparison indicated that the maximum amplitude of target neuron discharge was significantly smaller in the low BIS group than in the high BIS group(P < 0.05), and there was no statistical difference in other observation indexes. Conclusions MER signal decreases in different degrees under the general anesthesia of propofol combined with remifentanil, but it does not affect the recognition of STN characteristic signal. The general anesthesia with propofol and remifentanil has no effect on the precise positioning of the intraoperative electrodes and the surgical outcome, and it can be safely applied to ROSA-STN-DBS.
作者
徐明
陶英群
金海
巩顺
孙霄
宋丹丹
Xu Ming;Tao Yingqun;Jin Hai;Gong Shun;Sun Xiao;Song Dandan(Department of Anesthesiology,the General Hospital of Northern Theater Command,Shenyang,Liaoning 110016,China;Department of Neurosurgery,the General Hospital of Northern Theater Command,Shenyang,Liaoning 110016,China)
出处
《中国微侵袭神经外科杂志》
CAS
2021年第4期163-166,共4页
Chinese Journal of Minimally Invasive Neurosurgery
关键词
帕金森病
脑深部电刺激术
丘脑底核
麻醉
全身
机器人
Parkinson’s disease
deep brain stimulation
subthalamic nucleus
anesthesia
general
robotics
