经颅多普勒超声对后腹腔镜手术中脑血流的监测  

Changes of cerebra flow under monitoring of transcranial Dopple in posterior retroperitoneoscopic surgery

作　　者：薛纪秀[1] 华扬[2] 王克杰[1] 程维涛[1] 刘青海[1] 魏立民[1] 李京生[1] 

机构地区：[1]首都医科大学北京宣武医院麻醉科,北京100053 [2]首都医科大学北京宣武医院超声诊断科,北京100053

出　　处：《医学研究生学报》2007年第7期736-738,共3页Journal of Medical Postgraduates

基　　金：北京市自然科学基金资助项目(批准号:7042027)

摘　　要：目的:观察后腹膜入路腹腔镜手术中腹腔内CO2充气对脑血流动力学的影响。方法:选择22例后腹腔镜手术患者,在CO2充气前(T0)、充气后10min(T1)、30min(T2)、60min(T3)、90min(T4)和120min(T5)及停止充气后30 min(Te)等时间点,采用经颅超声多普勒(TCD)持续监测并记录患者双侧大脑中动脉平均血流速度(Vm)、血管搏动指数(PI)、血流速度变化百分比(Delt)等脑血流参数(以双侧均值统计),并同时观察和分析内皮素(ET),降钙素基因相关肽(CGRP),神经肽Y(NPY)等血管活性肽与大脑中动脉血流变化的相关性。结果:Vm、Delt于T2显著升高,T4达高峰,Te恢复,PI于T4降至最低,脑血流频谱呈明显的低搏动性改变,于Te期恢复,ET、NPY于T3显著升高,Te恢复,CGRP于T5显著降低,Te降至最低,且Delt与ET、NPY呈线性相关。结论:后腹腔镜手术中CO2充气可使患者Vm、Delt显著增加,PI降低,且该变化与血浆ET,NPY改变有关。通过TCD对脑血流的监测,可及时发现后腹腔镜手术中CO2浓度对脑血流的影响。Objective：To explore the changes of cerebra flow in retroperitoneoscopic surgery. Methods： Twenty-two patients undergoing retroperitoneoscopic surgery were selected. We measured Vm, Delt and PI with transcranial Dopple（ TCD）, and measured endothelin （ET）, neurol peptide Y（ NPY）, Calcitonin gene-related peptide（CGRP） in plasma before CO2 insufflation, after CO2 insufflation, and after CO2 deflation. Results：Vm and Deh increased significantly at 30 min after pneumoperitonenum, and reached the peak at 90 min after pneumoperitonenum. PI decreased significantly 90 min after pneumoperitonenum. The plasma concentrations of ET and NPY increased significantly 60 min after pneumoperitonenum. Conclusion：Cerebra flow changes significantly in patients undergoing retroperitoneoscopic surgery, which is correlated to the changes of plasma CO2 and vascular bioactive substances .

关 键 词：经颅多普勒超声 内皮素 降钙素基因相关肽 神经肽Y 

分 类 号：R699[医药卫生—泌尿科学]