妇科腹腔镜手术中Trendelenburg体位时脑血流动力学的变化

发布时间：2018-02-04 10:42

本文关键词： 腹腔镜经颅多普勒超声脑血流速度头低脚高位　出处：《临床麻醉学杂志》2015年05期 　论文类型：期刊论文

【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(P0.05);与T2时比较,T4~T6时Vm明显升高(P0.05),T4、T5时PI、CVP和T5时RI、CPP明显升高(P0.05);T5时Da-jvO2明显降低(P0.05),Da-jvCO2、SjvO2明显升高(P0.05)。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。
[Abstract]:Objective to monitor the changes of cerebral hemodynamics during Trendelenburg posture (T position) by transcranial Doppler ultrasound. Methods 40 patients undergoing elective laparoscopic gynecological surgery were studied. After general anesthesia, the internal jugular vein was placed in the bulbous part of the jugular vein to monitor the T _ (1), T _ (2), T _ (3) T _ (3) and T _ (4) and T _ (5) after anesthesia induction. The mean blood flow velocity of middle cerebral artery (MCA), pulsatile index (Pi), resistance index (RI), and cerebral perfusion pressure (CPP) were calculated, and the internal jugular venous pressure (IVP) was measured at T2. T5 was collected from the bulb of the internal jugular vein and the radial artery blood for blood gas analysis. The oxygen partial pressure difference (Da-jvO _ 2) and the carbon dioxide partial pressure difference (Da-jvCO _ 2) were calculated. Results compared with those at T1, the CPP of Vmna in T _ 2 patients was significantly lower than that in T _ 2 patients with Da-jv Lacs and Da-jv Glu.Results compared with T _ 1 patients, the CPP of Vmna in T _ 2 patients was significantly lower than that in T _ 2 patients. Compared with T2, VM was significantly increased at T4 / T6, P0.05 and T4 / T5, respectively. Da-jvO2 significantly decreased Da-jv CO _ 2 at T _ 5. Conclusion the cerebral hyperperfusion and cerebral oxygen uptake decreased in Trendelenburg postural position for 30 minutes. But there was no obvious metabolic disturbance in brain tissue.
【作者单位】：兰州大学第一临床医学院;兰州大学第一医院麻醉科;兰州大学第一医院神经内科;
【分类号】：R713
【正文快照】： Trendelenburg体位(以下简称T位)即头低脚高位,能使腹腔脏器移向头侧,方便术者操作,在妇科腔镜手术中使用广泛。Falabella等[1]研究证明,T位可引起腹腔镜手术中心脑血管血流改变和病理损伤,且倾斜程度可能影响这些改变的程度和患者预后。但妇科腔镜术中T位对脑血流灌注和脑代

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