TCD脑血流监测在颈动脉内膜剥脱术中指导血压调控的应用  

Application of TCD cerebral blood flow monitoring in guiding blood pressure regulation during carotid endarterectomy

作　　者：王彦 李俊青 郭全周 刘红霞 宋志俊 李丹 苗振华 WANG Yan;LI Jun-qing;GUO Quan-zhou;LIU Hong-xia;SONG Zhi-jun;LI Dan;MIAO Zhenhua(Department of Anesthesiology,Xingtai Third Hospital,Xingtai 054000,Hebei,China;Department of Function Division,Xingtai Third Hospital,Xingtai 054000,Hebei,China;Department of Neurosurgery,Xingtai Third Hospital,Xingtai 054000,Hebei,China)

机构地区：[1]邢台市第三医院麻醉科,河北邢台054000 [2]邢台市第三医院功能科,河北邢台054000 [3]邢台市第三医院神经外科,河北邢台054000

出　　处：《生物医学工程与临床》2024年第2期215-220,共6页Biomedical Engineering and Clinical Medicine

基　　金：邢台市重点研发计划项目(2021ZC102)。

摘　　要：目的探讨经颅彩色超声多普勒系统(TCD)监测脑血流在颈动脉内膜剥脱术(CEA)中指导血压个体化调控的作用。方法选择2018年12月至2020年12月在邢台市第三医院收治的140例拟行CEA治疗的颈动脉狭窄患者,其中男性74例,女性66例;年龄45~65岁,平均年龄57.41岁;糖尿病10例,高血压12例;美国麻醉师协会(ASA)分级:Ⅱ级30例,Ⅲ级110例。采用随机数字表法分为研究组和对照组,每组分为70例。对照组采用传统手段控制血压,研究组根据TCD脑血流参数指导调节血压。术中连续监测两组患者的有创动脉压力并对大脑中动脉平均血流速度进行监测。记录两组各个时刻点大脑中动脉血流速度(Vm)及外周有创动脉收缩压,比较两组患者围术期相关指标,统计术中心动过速/心动过缓发生次数及术后心脑血管事件发生情况。结果研究组术中硝酸甘油、去甲肾上腺素用量低于对照组[(34.87±10.27)μg vs(48.56±6.92)μg、(15.97±4.54)μg vs(24.15±3.99)μg。P<0.05],心动过缓发生率明显少于对照组(2.86%vs 19.40%。P<0.05)。在T00、T0、T3和T4时,两组间Vm值和收缩压比较,差异无统计学意义(P>0.05)。在T1和T2时,研究组Vm值和收缩压明显低于对照组[T1:(38.87±6.19)cm/s vs(44.42±4.16)cm/s,(119.84±8.12)mmHg vs(150.78±6.51)mmHg;T2:(29.46±4.58)cm/s vs(34.94±3.64)cm/s,(142.04±10.91)mmHg vs(152.23±5.84)mmHg。P<0.05]。其中两组患者在T2时Vm值显著下降[(29.46±4.58)cm/s vs(34.94±3.64)cm/s。P<0.05],收缩压值显著上升[(142.04±10.91)mmHg vs(152.23±5.84)mmHg。P<0.05]。研究组术后并发症发生率低于对照组(7.14%vs 20.90%。P<0.05)。研究组CEA后颈动脉超声心动图改变或术后再狭窄<50%、50%~69%和继发血栓形成的患者数明显少于对照组(2.86%vs 11.94%、2.86%vs 13.43%、1.43%vs 8.96%、0.00%vs 5.97%。P<0.05)。结论TCD监测颈动脉狭窄患者脑血管血流动力学对CEA麻醉中血压的调控具有较好的指导意义,有利于�Objective To investigate the role of transcranial color Doppler(TCD)in monitoring the cerebral blood flow to guide blood pressure individualized regulation during carotid endarterectomy(CEA).Methods From December 2018 to December 2020,a total of 140 patients with carotid artery stenosis scheduled for CEA treatment were enrolled,which included 74 males and 66 females,aged 45-65 years old with mean age of 57.41 years old.There were 10 cases of diabetes and 12 of hypertension.According to American Society of Anesthesiologists(ASA)classification,there were 30 cases of gradeⅡand 110 of gradeⅢ.According to random number table method,all of them were divided into study group and control group,with 70 cases in each group.The control group used traditional methods to control blood pressure,and study group adjusted blood pressure according to TCD cerebral blood flow parameters.During the operation,invasive arterial pressure was continuously monitored in 2 groups,and mean blood flow velocity of middle cerebral artery was also monitored.The middle cerebral artery blood flow velocity(Vm)and peripheral invasive arterial systolic pressure were recorded at each time point in 2 groups,and the perioperative related indicators of 2 groups were compared.The number of tachycardia/bradycardia and postoperative cardiovascular,cerebrovascular events were counted.Results During the operation,the dosage of nitroglycerin and norepinephrine in study group was significantly lower than that in control group[(34.87±10.27)μg vs(48.56±6.92)μg,(15.97±4.54)μg vs(24.15±3.99)μg.P<0.05],incidence of bradycardia was significantly lower than that in control group(2.86%vs 19.40%.P<0.05).At T00,T0,T3 and T4,there was no significant difference in Vm value and systolic pressure between 2 groups(P>0.05).At T1 and T2,the Vm value and systolic pressure of study group were significantly lower than those of control group[T1:(38.87±6.19)cm/s vs(44.42±4.16)cm/s,(119.84±8.12)mmHg vs(150.78±6.51)mmHg;T2:(29.46±4.58)cm/s vs(34.94±3.64)cm/s,(142.04�

关 键 词：颈动脉内膜剥脱术 经颅多普勒彩色超声检测系统 术中监测 脑血流 血压个体化调控 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445.1[医药卫生—临床医学]