头高位对糖尿病并发自主神经病变患者全麻下脑血流速度的影响

Effect of head-up tilt on cerebral blood flow velocity during general anesthesia in patients with diabetic neuropathy

目的评价头高位对糖尿病并发自主神经病变患者全麻下脑血流速度的影响。方法择期行全麻手术患者60例，ASA分级I或Ⅱ级，年龄40—60岁，体重52—70妇，按照合并糖尿病情况，将患者分为3组：非糖尿病患者对照组（c组）、无自主神经病变的糖尿病组（D组）和糖尿病并发自主神经病变组（ANS—D组），每组20例。全麻诱导气管插管后，于平卧位（T0）、头高位45°后1．5min（T1）、3.5min（T2）、5．5min（T3）时记录MAP和大脑中动脉血流速度（MBFV）。结果与T0时相比，C组和D组T1.2时MAP，T1时MBFV降低，ANS-D组T1-3时MAP和MBFV降低（P〈0．05），各组间比较MAP和MBFV差异无统计学意义（P〉0．05）。结论头高位时非糖尿病、无自主神经病变的糖尿病患者和糖尿病并发自主神经病变患者全麻下脑血流速度均降低且无差别。

Objective To investigate the effect of head-up tilt on cerebral blood flow velocity during general anesthesia in patients with diabetic neuropathy. Methods Sixty ASA I - 11 patients of both sexes aged 40-60 yr weighing 52-70 kg undergoing general anesthesia were divided into 3 groups according to diseases complicated with diabetes situation （ n = 20 each） ： group I normal control the patients did not have diabetes mellitus; group II type II diabetics without neuropathy and group III type II diabetics with neuropathy. Anesthesia was induced with propofol 2 mg/kg, fentanyl 3 ug/kg and vecuronium 0.1 mg/kg and maintained with 1% sevoflurane. The patients were intubated and mechanically ventilated. PET CO2 was maintained at 35-45 mm Hg. Transcranial doppler （TCD） was used to measure middle cerebral artery blood flow velocity （MBFV）. MAP and MBFV were measured and recorded in supine position （baseline） and at 1.5, 3.5 and 5.5 rain of 45° head-up tilt. Results The 3 groups were comparable with respect to age, body weight, height and M/F sex ratio. MAP and MBFV significantly decreased at 45° head-up tilt as compared with the baseline in all the 3 groups. There was no significant difference in MAP and MBFV among the 3 groups. Conclusion Cerebral blood flow velocity decreases when the patients are tilted 45° head-up during general anesthesia in both diabetics with and without neuropathy, but there is no significant difference between the 2 groups.