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丙泊酚Wada试验在脑功能区病变术前评估中的应用

Propofol Wada test in the application of preoperative evaluation in patients with functional cortex lesions

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目的 探讨丙泊酚Wada试验在脑功能区病变术前评估中的应用价值.方法 25例涉及脑功能区病变的患者在术前评估中采用丙泊酚进行Wada试验.23例癫(痫)患者采用颈内动脉注射,在半球注药麻醉期间对对侧半球进行语言、记忆和运动功能评估,并观察不良反应情况.2例功能区脑动静脉畸形患者采用畸形血管团供血动脉超选择性丙泊酚注射,观察注药后是否出现偏瘫,以决定是否进行供血动脉栓塞.结果 23例癫(痫)患者均完成语言优势半球和运动功能测试,其中17例完成患侧半球记忆功能测试,13例完成记忆优势半球测试.2例脑功能区动静脉畸形患者在介入治疗前共进行7次畸形血管供血动脉超选择性注射,在运动功能评估正常后进行栓塞治疗,术后肢体运动功能正常.在颈内动脉注射中,出现了以眼球刺激症状为主的不良反应,部分病例出现一过性意识错乱和肢体肌张力升高,虽不影响语言和运动功能测试,但对记忆功能测试造成了影响.结论 丙泊酚Wada试验虽然存在一定程度的不良反应,但是在脑功能区病变术前评估中仍有较高的应用价值.

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Objective To investigate the application value of propofol Wada test in the application of preoperative evaluation in patients with functional cortex lesions.Methods Twenty-five patients involving the lesions in the eloquent areas underwent preoperative evaluation with propofol wada test.Twenty-three patients with epilepsy were injected via internal carotid artery.The language,memory,and motor function of the 23 patients on the contralateral hemispheres were evaluate during the hemisphere injection of anesthesia using internal carotid artery injection,and their adverse effect reactions were observed.Two patients with cerebral arteriovenous malformations in the eloquent areas were super-selectively injected propofol using nidus feeding artery.Whether they had hemiplegia or not was observed after injection in order to determine whether to conduct feeding artery embolization.Results Twenty-three patients with epilepsy completed language dominant hemisphere and motor function tests,17 of them completed memory function tests on the ipsilateral hemispheres,and 13 completed dominant hemisphere tests.Seven malformation feeding artery super-selective injections were performed in 2 patients with cerebral arteriovenous malformations before intervention.Embolization was performed after the motor function assessment was normal.The limb motor function was normal after procedure.In the internal carotid artery injections,the eye irritation symptom dominated adverse reactions occurred,some patients had transient confusion and limb muscle tension increased.Although they did not affect language and motor function tests,they affected memory function tests.Conclusions Although the propofol wada test has a certain degree of adverse reactions,it still has a higher application value in preoperative evaluation in patients with functional cortex lesions

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