摘要： 目的 探讨清醒麻醉下切除脑功能区胶质瘤术中癫痫发作对术后情绪和肌力的影响。方法 纳入2020年9月至2022年9月空军军医大学附属西京医院诊断与治疗的90例胶质瘤患者，分别予以全身麻醉（GA组，30例）和清醒麻醉（60例），其中清醒麻醉患者术中无癫痫发作30例（AA组）、术中癫痫发作30例（AA+IE组）。术前和术后1周采用汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）和肌力划分法评估焦虑、抑郁情绪和肌力变化。结果 3组术后1周HAMD评分（F=9.985，P=0.000）和肌力（F=4.472，P=0.014）差异有统计学意义，其中AA组（q=3.177，P=0.014）和AA+IE组（q=9.468，P=0.000）HAMD评分高于GA组，AA+IE组亦高于AA组（q=6.290，P=0.003）；AA组（q=9.172，P=0.006）和AA+IE组（q=5.310，P=0.000）肌力高于GA组，但AA+IE组肌力低于AA组（q=3.862，P=0.007）。结论 清醒麻醉可加重术后抑郁情绪，但可改善肌力，且术中癫痫发作使术后抑郁情绪恶化、肌力改善作用降低，因此应提前制定合理预防与治疗方案，减少术中癫痫发生率。

关键词: 神经胶质瘤, 清醒镇静, 癫痫, 神经外科手术

Abstract: Objective To investigate the effect of intraoperative epileptic seizure on postoperative mood and muscle strength during awake anesthesia (AA) for the resection of gliomas. Methods A total of 90 patients with glioma admitted to Xijing Hospital, Air Force Military Medical University of Chinese PLA from September 2020 to September 2022 were collected and divided into general anesthesia group (GA group, n=30), awake anesthesia without intraoperative epileptic seizure group (AA group, n=30), and awake anesthesia with intraoperative epileptic seizure group (AA + IE group, n=30) according to the anesthesia method and the presence of intraoperative epileptic seizure. Patients' mood and muscle strength changes were assessed preoperatively and one week postoperatively by using Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD) and muscle strength division method. Results The differences in HAMD score (F=9.985, P=0.000) and muscle strength (F=4.472, P=0.014) at one week postoperatively were statistically significant among 3 groups. HAMD score was increased in AA group (q=3.177, P=0.014) and AA + IE group (q=9.468, P=0.000) when compared with GA group. HAMD scores was increased in AA + IE group (q=6.290, P=0.003) when compared with AA group. Postoperative muscle strength of AA group (q=9.172, P=0.006) and AA + IE group (q=5.310, P=0.000) was increased when compared with GA group. Muscle strength of AA + IE group was decreased compared with AA group (q=3.862, P=0.007). Conclusions Awake anesthesia can aggravate postoperative depression, but improve muscle strength. Intraoperative epileptic seizure can aggravate postoperative depression and decrease muscle strength. A reasonable preventive treatment plan needs to be developed in advance to reduce the incidence of intraoperative epileptic seizure.

Key words: Glioma, Conscious sedation, Epilepsy, Neurosurgical procedures