经颅彩色多普勒超声在术中脑血流监测中的可行性研究  

Feasibility of transcranial color Doppler in intraoperative cerebral blood flow monitoring

作　　者：刘雨 徐晓晓 谷梓毓 吴周全 Liu Yu;Xu Xiaoxiao;Gu Ziyu;Wu Zhouquan(Graduate School of Dalian Medical University,Dalian 116044,China;Department of Anesthesiology,Second People’Peopleent of Changzhou Affiliated to Nanjing Medical University,Changzhou 213100,China)

机构地区：[1]大连医科大学研究生院,辽宁大连116044 [2]南京医科大学附属常州第二人民医院麻醉科,江苏常州213100

出　　处：《中华卫生应急电子杂志》2023年第6期343-347,共5页Chinese Journal of Hygiene Rescue(Electronic Edition)

基　　金：江苏省高层次卫生人才"六个一工程"拔尖人才项目(LGY2020037);江苏省中医药科技发展计划项目(MS2021055)。

摘　　要：目的:应用经颅彩色多普勒超声(TCCD)监测术中不同血压及呼气末二氧化碳分压(PETCO_(2))下患者脑血流量的变化,以探讨TCCD在术中脑血流监测中的可行性。方法:选择2022年7月至2022年10月于南京医科大学附属常州第二人民医院行腹腔镜手术患者30例,其中男性16例,女性14例;年龄25~70岁,平均(57±19)岁。患者入室后均采用经颅多普勒(TCD)和TCCD分别测量大脑中动脉血流频谱信息,麻醉后均全程监测患者局部脑氧饱和度(rcSO_(2)),同时采用TCCD测量并计算麻醉诱导后血压正常时,PETCO_(2)分别≤35 mmHg(T1)、35 mmHg~45 mmHg(T2)、≥45 mmHg(T3);血压下降>30%时PETCO_(2)分别≤35 mmHg(T4)、35 mmHg~45 mmHg(T5)和≥45 mmHg(T6)六个时刻大脑中动脉的血流量。结果:(1)血压下降>30%时,大脑中动脉血流量较血压正常时明显降低(F=49.73,P<0.01)。(2)当血压维持一定时,随着PETCO_(2)逐渐增加,大脑中动脉血流量也逐渐增多(F=50.33,P<0.01),且血压与PETCO_(2)的影响具有交互作用(F=3.21,P<0.05)。(3)TCCD与TCD及rcSO_(2)具有良好的相关性。结论:TCCD能够实时有效监测术中脑血流量变化,且与TCD,rcSO_(2)具有良好的相关性,具有较好的临床应用价值。Objective To explore the feasibility of transcranial color Doppler ultrasound(TCCD)to monitor the changes of cerebral blood flow in patients with different intraoperative blood pressure and carbon dioxide partial pressure.Methods Thirty patients with laparoscopic elective surgery were selected,including 16 males and 14 females,aged 25~70 years,with an average age of(57lective surgery were selectedtranscranial Doppler and TCCD were used to measure the middle cerebral artery blood flow spectrum of all the patients,and to monitor cerebral oxygen saturation(rcSO_(2))throughout the process after anesthesia.At the same time,TCCD was used to measure and calculate cerebral blood flow after anesthesia induction at the time point of when the blood pressure was normal,PETCO_(2) was ect mmHg(T1),35 mmHg-45 mmHg(T2),and ti mmHg(T3),respectively;when the blood pressure decreased by more than 30%,PETCO_(2) was ect mmHg(T4),35 mmHg-45 mmHg(T5)and o45 mmHg(T6),respectively.Results Compared with the normal blood pressure,the cerebral arterial blood flow decreased significantly when the blood pressure decreased by more than 30%(F=49.73,P<0.010).When the blood pressure was maintained,with the gradual increase of PETCO_(2),the cerebral arterial blood flow also gradually increased(F=50.33,P<0.010),and blood pressure had an interaction with the influence of PETCO_(2)(F=3.21,P<0.050).TCCD had a good correlation with TCD and rcSO_(2).Conclusion TCCD can effectively monitor the changes of intraoperative cerebral blood flow in real time,and has a good correlation with TCD,rcSO_(2),and therefore it has good clinical application value.

关 键 词：经颅彩色多普勒 大脑中动脉血流 呼气末二氧化碳分压 血压 脑氧饱和度 脑灌注 

分 类 号：R54[医药卫生—心血管疾病]