腹腔镜手术体位因素对患者脑血流的影响  

Effects of different positions on cerebral blood flow in patients undergoing laparoscopic surgery

作　　者：王朔[1] 于流洋 陈凯[2] 石广志[2] 韩如泉[1] 

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,100050 [2]首都医科大学附属北京天坛医院综合ICU,100050

出　　处：《中华麻醉学杂志》2017年第4期420-422,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价腹腔镜手术体位因素对患者脑血流的影响。方法择期行腹腔镜手术患者30例，性别不限，年龄23～64岁，ASA分级Ⅰ或Ⅱ级。麻醉诱导稳定后，采用随机数字表法改变患者体位，分别取平卧位、头高脚低位（15°）、头低脚高位（15°），采用经颅多普勒超声监测大脑中动脉脑血流参数。分别于入室后（基础状态）、麻醉诱导后气腹前、平卧位、头高脚低位、头低脚高位时记录平均血流速度、搏动指数、阻抗指数、MAP和HR。结果与平卧位时比较，头高脚低位时MAP和双侧平均血流速度降低，头低脚高位时MAP、双侧搏动指数、双侧阻抗指数升高（P〈0.05）。结论腹腔镜手术中，头高脚低位可引起脑血流减少，头低脚高位对脑血流无明显影响。Objective To evaluate the effects of different positions on cerebral blood flow in patients undergoing laparoscopic surgery.Methods Thirty patients of both sexes, aged 23-64 yr, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, scheduled for elective laparoscopic surgery, were included.Patients′ position was changed using a random number table after induction of anesthesia.Patients were placed in the supine position and tilted 15° head-up or 15° head-down, and the parameters of the middle cerebral artery were monitored using the transcranial Doppler ultrasound.After admission to the operating room（baseline）, after induction of anesthesia and before pneumoperitoneum, in the supine position, at head-up tilt and at head-down tilt, the mean blood flow velocity, pulsatility index, resistance index, mean arterial blood pressure（MAP）and heart rate were recorded.Results Compared with the baseline in the supine position, the MAP and bilateral mean blood flow velocity were significantly decreased at head-up tilt, and the MAP and bilateral pulsatility and resistance indices were significantly increased at head-down tilt（P〈0.05）.Conclusion During laparoscopic surgery, head-up tilt can lead to a decrease in cerebral blood flow, and head-down tilt exerts no effect on cerebral blood flow.

关 键 词：腹腔镜手术 体位 脑血管循环 

分 类 号：R614[医药卫生—麻醉学]