腹腔镜手术对大脑中动脉血流的影响

Effects of laparoscopic surgery on middle cerebral artery blood flow

目的 观察腹腔镜胆囊切除术对病人大脑中动脉血流的影响。方法 采用TCD检测19例全麻病人在气腹前、气腹时和气腹后的平均血流速度 (Vm)、脉动指数 (PI)和无创动脉血压。结果 各时期Vm无明显变化 ;PI在气腹时明显增高 ,气腹后恢复正常 ;动脉收缩压和舒张压在气腹时增高 ,舒张压在气腹后仍高于气腹前水平。结论 腹腔镜胆囊切除术中CO2 气腹可通过CO2 吸收入血而使脑血管阻力有一定程度的改变 ,但只要PaCO2 维持在正常范围 ,CO2 对脑血流的影响不大。

Objective To evaluate the effect of laparocopic cholecystectomy on the middle cerebral artery blood flow.Methods 19 patients undergoing laparoscopic cholecystectomy under general anesthesia were included.Mean flow velocity (Vm),pulsatility index and blood pressure were measured with transcranial Doppler (TCD).Results Vm did not show any difference significantly at any time while pulsatility index rose during intraperitoneal insufflation and returned to the basal level after intraperitoneal deflation.Systolic and diastolic blood pressures increased during intraperitoneal insufflation and diastolic blood pressure was still higher than basal level.Conclusion Laparoscopic cholecystectomy can affect cerebral vessel resistance,but can not affect cerebral blood flow as long as PaCO 2 was kept in the normal limits.