학술논문
学龄期儿童发生切皮前低血压时颈内动脉和椎动脉的血流变化 / Changes of Blood Flow in Internal Carotid and Vertebral Artery during Preincision Hypotension in School-Age Children
Document Type
Academic Journal
Source
中国临床医学 / Chinese Journal of Clinical Medicine. (1):80-82
Subject
Language
Chinese
ISSN
1008-6358
Abstract
目的：通过测量右侧大脑的主要供血动脉———颈内动脉和椎动脉的血流变化来评估学龄期儿童发生切皮前低血压（preincision hypotension ，PIH）时脑血流量的变化。方法：选择44例行择期手术的患儿，美国麻醉医师协会（American Society of Anesthesiology ，ASA）分级Ⅰ～Ⅱ级，年龄7～13岁，无术前低血压、心脑血管疾病。入手术室后开放外周静脉，监测心率、收缩压、平均动脉压、脉搏氧饱和度；予异丙酚2．5 mg／kg、芬太尼2μg／kg、罗库溴铵0．6 mg／kg进行麻醉诱导；插管后机械通气，调整呼吸参数，维持呼气末二氧化碳分压35～40 mmHg ；应用七氟烷维持麻醉，呼气末浓度为1个最低肺泡有效浓度（minimum alveolar comcentration ，MAC）。通过多普勒超声测量麻醉诱导前和诱导后发生 PIH时颈内动脉和椎动脉血流的时间平均流速和血管内径。结果：发生 PIH 时，右侧颈内动脉的内径缩小、时间平均流速降低、血流量减少、阻力指数增加（P＜0．01）；椎动脉内径不变（P＞0．05），收缩期峰值流速、时间平均流速降低，血流量减少，阻力指数增加（P＜0．01）；右侧脑供血量减少（P＜0．01），颈内动脉供血比例减小（P＜0．01）。结论：学龄期儿童发生PIH时，即使平均动脉压高于脑血流自身调节下限，右侧颈内动脉和椎动脉血流量仍明显下降，右侧脑供血量明显减少。
Objective:To evaluate the cerebral blood flow during preincision hypotension (PIH ) in school‐age children by measuring the changes of blood flow in main supplying artery of right hemisphere such as internal carotid and vertebral artery . Methods :A total of 44 children ,aged 7‐13 years ,with American Society of Anesthesiology (ASA ) gradeⅠ‐Ⅱ ,who were scheduled for elective surgery ,were enrolled in this study .Patients with baseline hypotension ,cardiovascular diseases and cerebrovascular diseases were excluded .Heart rate ,systolic blood pressure ,mean arterial pressure ,pulse oxygen saturation were continuously monitored during the procedure .General anesthesia was induced with propofol 2 .5 mg/kg ,fentanyl 2 μg/kg , and rocuronium 0 .6 mg/kg .After intubation ,mechanical ventilation were used to control the breath .The patients received 1 minimum alveolar concentration(MAC) sevoflurane for maintaining the anestheia ,and the end tidal CO2 partial pressure was adjusted to 35‐40 mmHg .The change of blood flow in internal carotid and vertebral artery was evaluated by detecting the time averaged velocity and diameter with Doppler ultrasound .Blood flow index was measured before induction and at the time of PIH .Results:When PIH occurred ,in right side internal carotid artery ,the diameter reduced ,the time averaged velocity and the blood flow decreased ,and the resistance index increased(P<0 .01) .Meanwhile ,in vertebral artery ,the diameter restored (P>0 .05) ,the peak systolic velocity and the time averaged velocity decreased ,the blood flow reduced ,and the resistance index increased (P<0 .01) .The cerebral flow of right side decreased(P< 0 .01) ,and the internal carotid artery percentage contribution reduced(P<0 .01) .Conclusions :When PIH occurs in school‐age children ,although the mean arterial pressure is above the lower limit of autoregulation ,the blood flow of right side internal carotid and vertebral artery significantly decreases , and the cerebral flow of right side also decreases .
Objective:To evaluate the cerebral blood flow during preincision hypotension (PIH ) in school‐age children by measuring the changes of blood flow in main supplying artery of right hemisphere such as internal carotid and vertebral artery . Methods :A total of 44 children ,aged 7‐13 years ,with American Society of Anesthesiology (ASA ) gradeⅠ‐Ⅱ ,who were scheduled for elective surgery ,were enrolled in this study .Patients with baseline hypotension ,cardiovascular diseases and cerebrovascular diseases were excluded .Heart rate ,systolic blood pressure ,mean arterial pressure ,pulse oxygen saturation were continuously monitored during the procedure .General anesthesia was induced with propofol 2 .5 mg/kg ,fentanyl 2 μg/kg , and rocuronium 0 .6 mg/kg .After intubation ,mechanical ventilation were used to control the breath .The patients received 1 minimum alveolar concentration(MAC) sevoflurane for maintaining the anestheia ,and the end tidal CO2 partial pressure was adjusted to 35‐40 mmHg .The change of blood flow in internal carotid and vertebral artery was evaluated by detecting the time averaged velocity and diameter with Doppler ultrasound .Blood flow index was measured before induction and at the time of PIH .Results:When PIH occurred ,in right side internal carotid artery ,the diameter reduced ,the time averaged velocity and the blood flow decreased ,and the resistance index increased(P<0 .01) .Meanwhile ,in vertebral artery ,the diameter restored (P>0 .05) ,the peak systolic velocity and the time averaged velocity decreased ,the blood flow reduced ,and the resistance index increased (P<0 .01) .The cerebral flow of right side decreased(P< 0 .01) ,and the internal carotid artery percentage contribution reduced(P<0 .01) .Conclusions :When PIH occurs in school‐age children ,although the mean arterial pressure is above the lower limit of autoregulation ,the blood flow of right side internal carotid and vertebral artery significantly decreases , and the cerebral flow of right side also decreases .