腹膜后CO_2充气对脑血流及血管活性肽的影响

Alterations of Cerebral Blood Flow and Vasoactive Neuropeptides during Retroperitoneal CO_2 Insufflation

目的探讨以CO2充气为背景的手术中脑血流及血浆血管活性肽的变化及意义。方法选择19例接受后腹腔镜手术患者,ASAⅠ-Ⅱ级。分别于充气前、充气后30 min6、0 min1、20 min及停止充气30 min记录二氧化碳分压(PaCO2)、大脑中动脉血流速度(Vm)、血流速度变化百分比(Delt)、脉动指数(PI),并采集静脉血观察内皮素(ET)、降钙素基因相关肽(CGRP)、神经肽Y(NPY)、神经降压素(NT)在各时间点的变化。结果与充气前相比,各时间点PaCO2、Vm、Delt均有明显上升,PI下降,并有统计学意义,充气结束后,各值趋于正常。ET、CGRP、NPY、NT充气后均有上升,并在不同的时间点分别有显著或非常显著差异。结论以CO2充气为背景的后腹腔镜手术,升高的PaCO2及血浆血管活性物质共同作用,使脑血量处于增加状态。

Objective To investigate alterations the changes of cerebral blood flow and vasoactive neuropeptides during retroperitoneal CO2 insufflation. Methods 19 patients undergoing retroperitoneal laparoscopy were selected. Vmean,Delt and PI were measured with TCD, and endothelin （ET）, neuropeptide Y（NPY）, calcitonin gene-related peptide（CGRP）, neurotensin （NT） in plasma measured before CO2 insufflation, after CO2 insufflation, and after CO2 deflation . Results Vmean and Delt increased significantly after CO2 insufflation and PI decreased significantly. The plasma concentration of ET , NPY,CGRP and NT increased significantly at different times. Conclusion Cerebral blood flow is increased significantly in patients undergoing retroperitoneal laparoscopy, which is correlated to alterations of PaCO2 ,plasma vasoactive neuropeptides.