开颅和腹部手术患者苏醒期脑过度灌注现象的比较  

Comparison of cerebral hyperemia during emergence from general anesthesia for craniotomy and abdominal surgery

作　　者：杨笑宇[1] 周守静[1] 俞莹芳[1] 

机构地区：[1]复旦大学附属华山医院麻醉科,上海200040

出　　处：《复旦学报（医学版）》2008年第5期687-691,共5页Fudan University Journal of Medical Sciences

摘　　要：目的使用颈静脉球部血氧饱和度和经颅多普勒监测,研究手术苏醒期患者脑血流动力学的变化。方法随机选择择期在全麻下行开颅脑肿瘤切除术和腹部手术的患者,分为开颅手术组(Ⅰ组)(n=50)和腹部手术组(Ⅱ组)(n=50)。Ⅰ组患者术前行颈静脉球部置管,分别测术前,术后拔管即刻,拔管后30,60,90和120min时大脑中动脉平均血流速度(mean velocity of middle cerebral artery,MCA Vm),平均动脉压(mean arterialpressure,MAP)及颈静脉球部血氧饱和度(blood oxygen saturation of jugular vein bulb,SjvO2)。Ⅱ组分别测量术前,术后拔管即刻,拔管后30,60,90和120 min时的MCA Vm和MAP。结果Ⅰ组患者MCA Vm从术后拔管即刻到拔管后2 h间均较术前明显升高(P<0.05),Ⅱ组患者术后MCA Vm无明显升高,两组MCA Vm在各时点差异有统计学意义(P<0.05)。Ⅰ组患者术后SjvO2较术前显著升高,并维持至拔管后2 h(P<0.05)。Ⅰ组MCA Vm和同时点MAP值均不存在线性相关,和同时点SjvO2值在术后各点均存在正相关关系(P<0.05)。结论仅Ⅰ组术后发生脑过度灌注,脑过度灌注程度与血压无线性相关关系。Objective To define cerebral blood flow dynamics during postoperative emergence from anesthesia, via blood oxygen saturation of jugular vein bulb （SjvO2） and transeranial Doppler （TCD）. Methods Fifty patients undergoing craniotomy and 50 patients undergoing abdominal surgery were grouped to eraniotomy group （Group Ⅰ ） and abdominal surgery group （Group Ⅱ ） respectively. Jugular vein bulb was catheterized for all craniotomy patients. Mean velocity of middle cerebral artery （MCA Vm）, mean arterial pressure （MAP）, SjvO2 （only measured in Group Ⅰ） were measured before anesthesia, the moment of tracheal extubation, 30,60, 90, and 120 min after extubation in both groups. Results There was a significant increase in MCA Vm after extubation compared with the values before anesthesia in Group Ⅰ（P〈0.05）, while MCA Vm did not change in Group Ⅱ. The increase in MCA Vm in Group Ⅰ was significant at least for 120 min after extubation（P〈0.05）. There were significant differences in MCA Vm between the two groups （P〈0.05）. SjvO2 increased significantly after extubation（P〈0.05）, and maintained for 2 hours. There was correlation between MCA Vm and SjvO2 after extubation in Group Ⅰ （P〈0.05）. However, there was no linear correlation between MCA Vm and MAP observed at one time. Conclusions Cerebral hyperemia occurs exclusively in patients who have craniotomy. Its severity has no linear correlation with hypertention.

关 键 词：开颅手术 脑过度灌注 大脑中动脉平均血流速度 经颅多普勒 麻醉苏醒期 

分 类 号：R614.1[医药卫生—麻醉学]