中国医科大学学报

中国医科大学学报
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中国医科大学学报 ›› 2018, Vol. 47 ›› Issue (6): 503-506.doi: 10.12007/j.issn.0258‐4646.2018.06.006

• 论著 • 上一篇    下一篇

术中不同体位对脑血流速率及术后认知功能的影响

马铃1, 郭志伟2   

  1. 1. 中国医科大学附属盛京医院麻醉科, 沈阳 110004;
    2. 厦门大学附属第一医院麻醉科, 福建厦门 361005
  • 收稿日期:2017-12-04 出版日期:2018-06-30 发布日期:2018-05-29
  • 通讯作者: 马铃 E-mail:maling27@hotmail.com
  • 作者简介:马铃(1975-),女,副教授,博士.
  • 基金资助:
    国家自然科学基金(81302534)

Effect of Various Positions during Surgery on Cerebral Blood Flow Velocity and Postoperative Cognitive Function

MA Ling1, GUO Zhiwei2   

  1. 1. Department of Anesthesiology, Shengjing Hospital, China Medical University, Shenyang 110004, China;
    2. Department of Anesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen 361005, China
  • Received:2017-12-04 Online:2018-06-30 Published:2018-05-29

摘要: 目的 探讨体位变化对脑血流速率及术后早期认知功能的影响。方法 选择行全麻下择期腹腔镜手术ASA分级Ⅰ~Ⅱ级的患者20例,其中头高位手术10例(R组),头低位手术10例(T组)。术前1 d对患者进行简易精神状态量表(MMSE)评分,术中定时用超声多普勒检测2组患者左侧大脑中动脉血流速率,检测时间分别为诱导插管后水平位时(t1),体位变化时0 min (t2)、10min (t3)、30 min (t4)、50 min (t5),恢复水平位后(t6),术后第1天再次对患者进行MMSE评分。比较2组患者术中脑血流速率和术后MMSE评分是否有差异。结果 R组和T组比较,t1、t2、t3、t4、t6时2组的脑血流速率无统计学差异(P>0.05),t5时T组脑血流速率高于R组(P<0.05)。T组术中脑血流速率较大,术后MMSE评分高于R组(P<0.05),所以术中高脑灌注可以提高术后MMSE评分。结论 术中头低位患者脑血流速率高于头高位患者脑血流速率,术中高脑血流速率可以提高术后MMSE评分。

关键词: 经颅多普勒, 体位, 脑血流速率, 认知功能

Abstract: Objective To explore the effect of postural changes on cerebral blood flow velocity and early postoperative cognitive function. Methods Twenty patients belonging to American Society of Anesthesiologists gradeⅠor Ⅱ, who underwent laparoscopic surgery under general anesthesia were selected, with 10 patients in the reverse Trendelenburg position (group R) and 10 patients in the Trendelenburg position (group T) intraoperatively. Mini-mental state examination(MMSE) score of each patient was assessed one day before operation. The left middle cerebral artery blood flow was detected using transcranial Doppler during operation at the following time points:horizontal position after intubation (t1), position change 0 min (t2), 10 min (t3), 30 min (t4), 50 min (t5), horizontal position after recovery (t6), respectively. The MMSE score was reassessed one day after operation. The differences in brain blood flow rate and postoperative score were compared between the two groups. Results There was no significant difference in the cerebral blood flow rate between the two groups at t1, t2, t3, t4 and t6 (P>0.05). The cerebral blood flow rate in two groups was significantly different at t5 (P<0.05). The postoperative MMSE score of the two groups was not significantly different before surgery, but demonstrated a significant difference after surgery. Conclusion The cerebral blood flow rate in the Trendelenburg position is higher than that in the reverse Trendelenburg position, and a higher cerebral blood flow can increase the MMSE score after operation.

Key words: transcranial Doppler, body position, cerebral blood flow velocity, postoperative cognitive dysfunction

中图分类号: 

  • R614.2
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