经颅多普勒超声评价神经外科麻醉对脑血流动力学的影响

Evaluation on the Effect of General Anesthesia on Cerebral Hemodynamics by TCD during Neurosurgery

目的应用经颅多普勒超声动态监测神经外科麻醉期间脑血流动力学变化,探讨麻醉对脑血流动力学的影响。方法随机抽取我科29例全麻手术患者,分成颅内疾病手术组(A组)与脊柱、脊髓疾病手术组(B组),应用TCD对术前、麻醉、术始、术中、术毕和术后六个时程连续监测脑血流速度。全麻采用异丙酚为主辅以异氟醚/氧化亚氮的静吸互补麻醉方式。结果麻醉、术始及术中三个时程与术前相比VP和VM两个参数间差别有显著性意义(P<0·05),三者VP和VM两个参数间差别无显著性意义(P>0·05);整个麻醉期间PI变化间差别无显著性意义(P>0·05);A、B两组麻醉期间BP、HR、SPO2、PETCO2变化均无显著性意义(P>0·05);A、B两组各时程脑血流动力学变化相比,VP间差别有显著性意义(P<0·05),而VM与PI间差别无显著性意义(P>0·05);麻醉期间TCD波形与术前间差别无显著性意义(P>0·05);整个麻醉期间未闻及异常TCD血流声频。结论应用TCD可以评价神经外科麻醉期间脑血流动力学变化,全麻后脑血流速度明显下降。

Objective To evaluate the effect of general anesthesia on cerebral circulation measured by TCD during neurosurgery. Methods 29 patients under general anesthesia were randomized into craniocerebral disease operation group （group A） and spinal or spinal cord disease operation group （group B）. The cerebra/blood flow velocity was observed continuously by using TCD and was recorded at six time intervals： preoperation, postinduction of anesthesia, the beginning of surgery, intraoperation, the end of surgery and postoperation. Anesthesia was induced with propofol, and maintained with propofol and N2O/isoflurane. Results The Vp and Vm were markedly different in postinduction, the beginning of surery and intraoperation compared with preoperation （ P 〈 0. 05）, but not significantly different among them （ P 〉 0.05 ）. The PI changes were not significantly different during the entire anesthesia （ P 〉 0. 05 ）. The changes of BP, HR, SPO2, PEr CO2 during anesthesia were not significantly different between group A and group B （ P 〉 0. 05 ） . The changes of Vp were significantly different between group A and group B （ P 〈 0. 05）, but the changes of VM and PM were not significantly different between group A and group B （ P 〉 0.05 ）. The changes of TCD wave shape were not significantly different compared with preoperation （ P 〉 0.05）. Abnormal blood flow acoustic frequency of TCD was not detected during the entire anesthesia. Conclusion TCD can be used to evaluate the effect of general anesthesia on cerebral hemodynamics. The cerebral blood flow velocity is significantly de- creased during general anesthesia.