经颅彩色多普勒超声在围术期多模态脑功能监测中的应用研究

目的探讨在围术期患者多模态脑功能监测中使用经颅彩色多普勒超声(TCCS)判断脑血流和脑功能情况的应用价值。方法40例择期手术时间>3 h,全身麻醉下行腹腔镜手术的患者,采用随机数字表法分为L组[二氧化碳气腹压力<10 mm Hg(1 mm Hg=0.133 kPa)]和H组(二氧化碳气腹压力15 mm Hg),每组20例。两组患者在麻醉前(T1)、气腹前(T2)、气腹后(T3)、手术后(T4)在颞窗行经颅多普勒彩色超声检查,比较两组患者各时间点脑电双频指数(BIS)、收缩期峰流速(PSV)、舒张期末流速(EDV)、平均脑血流速度(mCBFV)、搏动指数(PI)水平以及Ramsay镇静评分。结果L组患者Ramsay镇静评分为(3.94±1.28)分高于H组的(1.57±1.04)分,差异有统计学意义(t=6.427,P<0.05);T3时H组EDV、PI、BIS水平为(9.82±3.16)cm/s、(0.50±0.30)、(36.27±7.66)均低于L组的(18.95±3.50)cm/s、(0.69±0.20)、(40.50±3.41),mCBFV水平(115.46±18.00)cm/s高于L组的(101.56±22.2)cm/s;T4时H组EDV、PI、BIS水平为(12.06±3.10)cm/s、(0.81±0.16)、(41.25±8.24)均低于L组的(16.60±3.12)cm/s、(1.11±0.15)、(45.36±3.89),mCBFV水平(102.61±18.00)cm/s高于L组的(87.65±23.50)cm/s,差异均有统计学意义(P<0.05)。结论经颅彩色多普勒超声在围术期监测脑血流动力学简便、可靠,在围术期患者脑功能监测的过程中具有指导意义。

Study on application of transcranial color-coded sonography in perioperative multimodal brain function monitoring

Objective To discuss the application value of transcranial color-coded sonography in multimodal brain function monitoring of perioperative patients.Methods A total of 40 patients with elective operation time>3 h and laparoscopic operation under general anesthesia were randomly divided into group L[CO2 pneumoperitoneum pressure<10 mm Hg(1 mm Hg=0.133 kPa)]and group H(CO2 pneumoperitoneum pressure 15 mm Hg),with 20 patients in each group.Transcranial color-coded sonography was performed before anesthesia(T1),before pneumoperitoneum(T2),after pneumoperitoneum(T3)and after operation(T4)in the two groups.The bispectral index(BIS),peak systolic velocity(PSV),end diastolic velocity(EDV),mean cerebral blood flow velocity(mCBFV),pulsatile index(PI)and Ramsay sedation score at different time points were compared between the two groups.Results The Ramsay sedation score(3.94±1.28)points in group L was higher than(1.57±1.04)points in group H,and the difference was statistically significant(t=6.427,P<0.05).At T3,the levels of EDV,PI and BIS were(9.82±3.16)cm/s,(0.50±0.30)and(36.27±7.66)in group H,which was lower than(18.95±3.50)cm/s,(0.69±0.20)and(40.50±3.41)in group L,and mCBFV(115.46±18.00)cm/s was higher than(101.56±22.2)cm/s in group L.At T4,the levels of EDV,PI and BIS were(12.06±3.10)cm/s,(0.81±0.16)and(41.25±8.24)in group H,which was lower than(16.60±3.12)cm/s,(1.11±0.15)and(45.36±3.89)in group L,and mCBFV(102.61±18.00)cm/s was higher than(87.65±23.50)cm/s in group L.Their difference was statistically significant(P<0.05).Conclusion Transcranial color-coded sonography is a simple and reliable method for monitoring cerebral hemodynamics in perioperative period,which has guiding significance in the process of monitoring brain function in perioperative patients.