颈过伸体位对颈动脉血流的影响及其与头痛不适相关性的实验研究  

Influence of hyperextension position on carotid artery blood flow and its association with headache discomfort:An experimental study

作　　者：赵雯婷 邢光辉 马燕兰[3] ZHAO Wenting;XING Guanghui;MA Yanlan(Chinese PLA Medical School,Beijing 100853,China;The Fourth Medical Center,Chinese PLA General Hospital,Beijing 100048,China;Nursing Department,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第四医学中心,北京100048 [3]解放军总医院护理部,北京100853

出　　处：《解放军医学院学报》2021年第3期339-343,共5页Academic Journal of Chinese PLA Medical School

基　　金：解放军总医院临床科研扶持基金(三〇四专项)(2018FC-304Z-TSYS-01)。

摘　　要：背景有研究显示颈过伸体位下椎动脉血流会下降,但目前并没有研究动态监测颈动脉血流变化,实时记录患者的真实体验,进而证明过伸体位下颈动脉血流变化与头痛不适的关系。目的探讨颈过伸体位对甲状腺手术患者术中颈动脉血流动力学的影响,分析其变化与患者术后头痛不适的相关性。方法选取20名20~30岁的健康志愿者,于2019年5月在解放军总医院第四医学中心超声科模拟甲状腺手术术中过伸体位,多普勒超声分别测定志愿者平卧位及过伸体位10 min、20 min、30 min、40 min、50 min时颈总动脉和椎动脉血流变化,同时记录志愿者感觉头痛不适时间、症状。结果采取过伸体位时双侧颈总动脉和椎动脉平均血流速度较平躺时明显降低(P<0.05),血流量较平躺时明显减少(P<0.05),颈总动脉峰值收缩速度较平躺时明显降低(P<0.05)。试验过程中有13名志愿者出现不同程度的头晕、头痛、肩部不适症状,头痛不适发生率为65%。且随着颈过伸体位时间延长,头痛不适程度与左椎平均流速、左椎血流量、左椎收缩期峰值流速、右颈总血流量及右椎收缩期峰值流速均呈负相关(P<0.05)。结论过伸体位对颈动脉血流动力学有一定影响,可能对甲状腺手术患者术后头痛不适也有影响。Background Although studies have shown that blood flow of the vertebral arteries will decrease in the hyperextension position,no studies have been conducted to monitor the dynamic changes of carotid artery blood flow,record the real experience of patients in real time,and thus prove the association of the change in carotid artery blood flow with headache discomfort in the hyperextension position.Objective To investigate the influence of the hyperextension position on carotid hemodynamics in patients undergoing thyroid surgery and the association of the change in carotid hemodynamics with postoperative headache discomfort.Methods A total of 20 healthy volunteers,aged 20-30 years,were selected to simulate the hyperextension position during thyroid surgery in department of ultrasound in our hospital in May 2019.Doppler ultrasound was used to measure the changes in the blood flow of the common carotid artery and the vertebral artery in the supine position and the hyperextension position at 10,20,30,40,and 50 minutes,and the time and symptoms of headache discomfort were recorded at the same time.Results The mean blood flow velocity of both common carotid arteries and vertebral arteries in the hyperextension position was significantly lower than that in the supine position(P<0.05),and the blood flow volume in the hyperextension position was also significantly lower than that in the supine position(P<0.05).The peak systolic velocity of the common carotid artery in the hyperextension position was significantly lower than those in the supine position(P<0.05).During the experiment,13 volunteers developed varying degrees of dizziness,headache,and shoulder discomfort,and the incidence rate of headache discomfort was 65%.In the hyperextension position,the degree of headache discomfort was negatively correlated with the mean blood flow velocity,blood flow volume,and peak systolic velocity of the left vertebral artery,the blood flow volume of the right common carotid artery,and the peak systolic velocity of the right vertebral

关 键 词：甲状腺 颈过伸体位 椎动脉 血流动力学 头痛 

分 类 号：R653[医药卫生—外科学]