摘要
目的应用经颅多普勒超声监测Trendelenburg体位（简称T位）时脑血流动力学的变化。方法择期腹腔镜下妇科手术患者40例,常规全身麻醉后行颈内静脉球部置管,监测麻醉诱导前（T1）、麻醉诱导后（T2）、气腹后（T3）、T位即刻（T4）、T位后30min（T5）、体位恢复后（T6）大脑中动脉平均血流速度（Vm）、搏动指数（PI）、阻力指数（RI）,计算脑灌注压（CPP）。同时测量颈内静脉压,并于T2、T5采颈内静脉球部、桡动脉血进行血气分析。计算动-颈内静脉氧分压差（Da-jvO2）、二氧化碳分压差（Da-jvCO2）、血乳酸浓度差（Da-jvLac）和血糖浓度差（Da-jvGlu）。结果与T1时比较,T2时患者Vm、CPP明显降低（P〈0.05）;与T2时比较,T4～T6时Vm明显升高（P〈0.05）,T4、T5时PI、CVP和T5时RI、CPP明显升高（P〈0.05）;T5时Da-jvO2明显降低（P〈0.05）,Da-jvCO2、SjvO2明显升高（P〈0.05）。结论 Trendelenburg体位30min存在大脑过度灌注和脑氧摄取量减少,但未造成明显脑组织代谢障碍。
Objective To monitor the change of cerebral blood flow of patients with gynecological endoscopy surgery under Trendelenburg position by transcranial doppler ultrasound,and explore its relationship with the metabolism of brain tissue.Methods We included forty patients with gynecological surgery under regular general anesthesia,and put the internal catheter into jugular vein ball then.We monitored average blood flow velocity of middle cerebral artery（Vm）,pulse index（PI）,resistance index（RI）before anesthesia induction（T1）,after induction（T2）,after pneumoperitoneum（T3）,Trendelenburg position immediately（T4）,after 30 min later（T5）,horizon position（T6）,calculated cerebral perfusion pressure,and measured internal jugular venous pressure at the same time.We drawed blood from internal jugular vein ball and radial artery for blood gas analysis at T2,T5,and calculated Da-jvO2,Da-jvCO2,Da-jvLac,Da-jvGlu.Results Compared with T1,Vm,CPP at T2decreased（P〈0.05）;Compared with T2,T4-T6 Vm increased significantly（P〈0.05）,PI,CVP increased at T4,T5（P〈0.05）,RI and CPP increased at T5,Da-jvO2decreased（P〈0.05）;Da-jvLac and SjvO2 elevated.Conclusion 30 min after Trendelenburg position,cerebral hyperperfusion and decreased cerebral oxygen consumption occured,but caused no brain metabolic disorders.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2015年第5期436-438,共3页
Journal of Clinical Anesthesiology
关键词
腹腔镜
经颅多普勒超声
脑血流速度
头低脚高位
Laparoseopic
Transeranial doppler ultrasound
Cerebral blood flow
Trendelenburg position
