摘要目的 探讨难治性癫痫患者进行丙泊酚Wada试验时,影响语言及记忆功能测试的相关危险因素.方法 于2010年1月至2013年8月对23例癫痫患者采用颈内动脉注射丙泊酚进行Wada试验,记录患者语言及记忆测试任务的完成情况,根据完成情况分组,收集患者年龄、癫痫病程、利手侧、全量表智商、病灶侧别、语言优势半球侧别、丙泊酚动脉注射剂量及不良反应等相关数据,运用SPSS统计软件分析筛选影响语言及记忆测试的相关因素.结果 23例患者均完成语言优势半球测试,13例患者完成记忆优势半球测试,两试验完成率差异有统计学意义(P=0.001).单因素分析,完成记忆测试组与未完成记忆测试组的病程分别为(10.57±4.68)年和(18.30±9.30)年,全量表智商分别为(81.00±25.33)分和(64.20±10.86)分,均差异有统计学意义(P=0.032,P=0.046);而患者年龄、利手侧、病灶侧别、语言优势半球侧别,丙泊酚注射剂量差异无统计学意义.丙泊酚注射后,两组Ⅱ级不良反应的发生率差异有统计学意义(P=0.006);Logistic回归分析提示Ⅱ级不良反应对记忆测试存在影响(OR=28.0,P＜0.01).结论 丙泊酚Wada试验是测定语言优势半球的较好方法,影响测试的因素少.记忆功能测试的影响因素较为复杂,癫痫病程、全量表智商、丙泊酚动脉注射后的Ⅱ级不良反应均是导致记忆优势半球测试失败的影响因素,而Ⅱ级不良反应可能在其中起主导作用.

abstractsObjective To investigate the effect factors for language and memory dominance testing in propofol Wada test in refractory epilepsy patients.Methods From January 2010 to August 2013,total of 23 patients underwent propofol Wada tests for language and memory dominance evaluation.According the performance in language test and memory test,the patients were divided into two groups,respectively:succeed with test or failed in test.The relevant factors including age,duration of epilepsy,handedness,FIQ (full scale of intelligence quotient),lateralization of lesions,language dominance,dose of propofol and the adverse effects of propofol were recorded as independent variables.Logistic regression was adopted to screen the effect factors for memory dominance evaluation.All statistical analyses were processed with SPSS software.Results All 23 patients succeeded with language test,but only 13 patients succeed with memory test.The difference of success ratios between language test and memory test was significant (P=0.001).For memory test,the difference of duration of epilepsy and FIQ in success group and failed group was significantly different (duration of epilepsy:(10.57±4.68) vs (18.30±9.30),P=0.032,FIQ:(81 ±25.33) vs (64.2±10.86),P=0.046).More grade Ⅱ adverse effects of propofol occured in the patients who failed in memory test (P=0.011).Logistic regression results indicated the grade Ⅱ adverse effects of propofol were the main risk factor for memory test failure (OR=28.0,P＜0.01).Conclusions Propofol Wada test is an effective method for language dominance evaluation.However,the effect factors for memory dominance evaluation are much more than language evaluation,such as duration of epilepsy,FIQ and grade Ⅱ adverse effects of propofol,and grade Ⅱ adverse effects of propofol may be the most significant risk factor.