麻婷婷,常媛媛,滕秀飞,杨延超,李阳,朱俊超
MA Ting-ting,CHANG Yuan-yuan,TENG Xiu-fei,YANG Yan-chao,LI Yang,ZHU Jun-chao

• 1:中国医科大学附属盛京医院麻醉科

摘要(Abstract)：

目的探讨局部麻醉手术中右美托咪定镇静下患者定量脑电图(quantitative pharmaco-electroencephalography,QPEEG)δ及α1波频率的变化。方法择期行局部麻醉手术患者40例,随机分为观察组和对照组,每组20例,观察组患者经鼻给予右美托咪定1μg/kg,对照组患者经鼻给予等量生理盐水。记录2组患者安静状态下(T0)、给药后20min(T1)和60min(T2)的脑电图,计算QPEEG的δ和α1波频率。结果观察组T2时左额区、右额区、左颞区、右颞区δ波频率[(8.72±0.58)、(8.52±0.68)、(8.61±0.84)、(8.59±0.79)Hz]明显高于T0时[(7.10±1.90)、(7.25±2.75)、(7.36±2.86)、(7.28±1.71)Hz]和T1时[(8.05±2.45)、(8.11±2.60)、(8.10±2.77)、(7.81±1.93)Hz],α1波频率[(7.92±1.78)、(8.22±1.65)、(8.52±2.14)、(8.59±1.75)Hz]明显低于T0时[(11.84±1.75)、(11.25±1.64)、(12.06±2.16)、(11.48±1.74)Hz]和T1时[(11.21±1.31)、(10.11±2.13)、(10.61±1.25)、(10.81±1.53)Hz](P<0.05),T1时与T0时比较差异无统计学意义(P>0.05);对照组患者T0、T1、T2时左额区、右额区、左颞区、右颞区δ、α1波频率比较差异均无统计学意义(P>0.05);观察组T2时左额区、右额区、左颞区、右颞区δ波频率高于对照组[(8.12±0.54)、(7.89±0.59)、(7.97±0.69)、(7.94±0.84)Hz],α1波频率明显低于对照组[(11.74±1.64)、(10.89±1.27)、(10.97±2.65)、(11.94±1.82)Hz](P<0.05),T0和T1时与对照组比较差异无统计学意义(P>0.05)。结论经鼻滴入右美托咪定后,局部麻醉手术患者定量脑电图δ波波动增加,α1波波动减少,δ和α1波频率变化可反映右美托咪定的镇静效果。
Objective To observe the changes ofδ-and α1-band of quantitative pharmaco-electroencephalography(QPEEG)under dexmedetomidine sedation in local anesthesia.Methods Forty patients receiving selective operation under local anesthesia were randomly divided into observation group and control group,with 20 patients in each group.Observation group received nasal dexmedetomidine 1μg/kg,and control group was given the equivalent volume of normal saline.The electroencephalography changes at the time points of quiet state(T0),20 min after administration(T1)and60 min after the administration(T2)were recorded and the frequencies of theδ-andα1-band of QPEEG were calculated.Results In observation group,the frequencies ofδ-band on the left and right frontal area,and left and right temporal area at T2((8.72±0.58),(8.52±0.68),(8.61±0.84),(8.59±0.79)Hz)were significantly higher than those at T0((7.10±1.90),(7.25±2.75),(7.36±2.86),(7.28±1.71)Hz)and T1((8.05±2.45),(8.11±2.60),(8.10±2.77),(7.81±1.93)Hz),the frequencies ofα1-band were significantly lower at T2((7.92±1.78),(8.22±1.65),(8.52±2.14),(8.59±1.75)Hz)than those at T0((11.84±1.75),(11.25±1.64),(12.06±2.16),(11.48±1.74)Hz)and T1((11.21±1.31),(10.11±2.13),(10.61±1.25),(10.81±1.53)Hz)(P<0.05),and there were no significant differences between T0 and T1(P>0.05).In control group,the frequencies ofδ-andα1-band at T0,T1 and T2 showed no significant differences in the left and right frontal area,and left and right temporal area(P>0.05).The frequencies ofδ-band on the left and right frontal area,and left and right temporal area at T2 in observation group were significantly higher than those in control group((8.12±0.54),(7.89±0.59),(7.97±0.69),(7.94±0.84)Hz),the frequencies ofα1-band on the left and right frontal area,and left and right temporal area in observation group were significantly lower than those in control group((11.74±1.64),(10.89±1.27),(10.97±2.65),(11.94±1.82)Hz)(P<0.05),and there were no significant differences between T0 and T1(P>0.05).Conclusion The increase ofδ-band and the decrease ofα1-band after nasal dexmedetomidine could reflect the sedative effect of dexmedetomidine.

关键词(KeyWords)： 右美托咪定;定量脑电图;δ频段;α_1频段
Dexmedetomidine;quantitative pharmaco-electroencephalograph;δ-band;α_1-band

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金(81401231)

作者(Author): 麻婷婷,常媛媛,滕秀飞,杨延超,李阳,朱俊超
MA Ting-ting,CHANG Yuan-yuan,TENG Xiu-fei,YANG Yan-chao,LI Yang,ZHU Jun-chao

参考文献(References)：

• [1]GREEN D,PAKLET L.Latest developments in peri-operative monitoring of the high-risk major surgery patient[J].Int J Surg,2010,8(2):90-99.
• [2]赵平,于威威,季海音.右美托咪定滴鼻对小儿苏醒期躁动的预防作用[J].中国医师杂志,2013,15(7):895-898.
• [3]HERMANN W M,IRRGANG U.An absolute must in clinicopharmacological research:pharmacoelectroencephalography,its possibilities and limitations[J].Pharnacopsyehiatria,1983,16(5):134-142.
• [4]IRWIN P.Spectral difference index:a single EEG measure of drug effect[J].Electroencephalogr Clin Neurophysiol,1982,54(3):342-346.
• [5]张小雷,侯沂.定量药物脑电图预测氟哌啶醇对精神分裂症的疗效[J].中华神经精神科杂志,1992,25(5):300-302.
• [6]ITIL T M.The discovery of antidepressant drugs by computeranalyzed human cerebral bio-electrical potentials(CEEG)[J].Prog Neurobiol,1983,20(3/4):185-249.
• [7]刘颖,何霞,肖天科.右美托咪定预防腰硬联合麻醉下经尿道前列腺电切术中寒战的临床观察[J].医药论坛杂志,2013,34(10):25-26.
• [8]苏靖心,董铁立.右美托咪定临床应用[J].中华实用诊断与治疗杂志,2012,26(6):521-522.
• [9]宋直雷,孟凡民,张加强.右美托咪定在颅内动脉瘤手术中的脑保护作用[J].中华实用诊断与治疗杂志,2013,27(9):859-861.
• [10]YUEN V M,IRWIN M G,HUI T W,et al.A double-blind,crossover assessment of the sedative and analgesic effects of intranasal dexmedetomidine[J].Anesth Analg,2007,105(2):374-380.
• [11]DERYK L,JEFFREY W,STEPHEN Q,et al.Use of intranasal dexmedetomidine for preoperative sedation in fifteen pediatric patients[J].Anesthesiology,2008,109(1):137-140.
• [12]WANG L,WANG X D.Pharmacokinetic and pharmacodynamic effects of clonazepam in children with epilepsy treated with valproate:apreliminary study[J].Ther Drug Monit,2002,24(4):532-536.
• [13]OHTANI Y,KOTEGAWA T,TSUTSUMI K,et al.Effect of fluconazole on the pharmacokinetics and pharmacodynamics of oral and rectal bromazepam:an application of eletroencephalography as the pharmacodynamic method[J].J Clin Pharmaco,2002,42(2):183-191.
• [14]王宏玉,李阳,杨延超,等.盐酸右美托咪定对脑额叶α1和θ频率的影响[J].中华实用诊断与治疗杂志,2017,31(12):1209-1211.
• [15]BAKER G W,SLEIGH J W,SMITH P.Electroencephalographic indices related to hypnosis and amnesia during propofol anaesthesia for cardioversion[J].Anaesth Intensive Care,2000,28(4):386-391.
• [16]陆伟,刘丽,龚敬,等.脑电双频指数监测在调控右美托咪定镇静深度中的应用[J].中华全科医学,2014,11(4):574-575.
• [17]李贺,赵健,韦慧,等.芬太尼对兔定量脑电图β2频段功率百分比的影响[J].中国药理学通报,2013,29(8):1128-1132.
• [18]BISCHOFF P,SCHAREIN E,SCHIMIDT G N,et al.Topography of clonidine-induced electroencephalographic changes evaluated by principal component analysis[J].Anesthesilolgy,2000,92(6):1545-1552.