Department of Anaesthesiology, Huashan Hospital, Fudan University, Shanghai, China.
Acta Anaesthesiol Scand. 2013 Nov;57(10):1301-7. doi: 10.1111/aas.12176. Epub 2013 Aug 23.
Few studies look into cerebral blood flow (CBF) changes during emergence from general anaesthesia for craniotomy. The purpose of this study was to assess CBF changes during emergence from general anaesthesia for craniotomy, through monitoring blood oxygen saturation of jugular vein bulb (SjvO2 ) and transcranial Doppler (TCD).
We enrolled 30 patients undergoing selective craniotomy (group C) for supratentorial brain tumour resection and 30 patients undergoing selective abdominal surgery (group A). Mean velocity of middle cerebral artery (Vmca), mean arterial pressure (MAP), SjvO2 (only measured in group C), and arterial CO2 partial pressure were measured before anaesthesia, at tracheal extubation, and 30, 60, 90, 120 min after extubation.
Vmca of the same side of tumour was significantly higher than contralateral Vmca before anaesthesia and at all times after extubation in group C. The ipsilateral Vmca increased significantly (95.7 ± 16.9 cm/s vs. 63.7 ± 6.7 cm/s, P < 0.01) at extubation in group C, then declined but still above baseline significantly in the first 2 h after extubation. While Vmca of the right side changed only slightly (63.6 ± 7.7 cm/s vs. 61.8 ± 8.1 cm/s, P < 0.01) but significantly at extubation in group A. SjvO2 increased significantly (81.4% ± 7.4% vs. 60.9% ± 3.7%, P < 0.01) at extubation in group C, and remained above baseline significantly for 2 h. There was no significant correlation between Vmca and MAP at any time.
Cerebral hyperaemia occurs after supratentorial brain tumour resection surgery. The hyperaemia is more pronounced on the same side as the tumour.
很少有研究关注颅脑手术全身麻醉苏醒期间的脑血流（CBF）变化。本研究旨在通过监测颈静脉球血氧饱和度（SjvO2）和经颅多普勒（TCD）评估颅脑手术全身麻醉苏醒期间的 CBF 变化。
我们纳入了 30 例行择期颅脑肿瘤切除术的患者（C 组）和 30 例行择期腹部手术的患者（A 组）。在麻醉前、气管拔管时以及拔管后 30、60、90、120 分钟测量大脑中动脉平均流速（Vmca）、平均动脉压（MAP）、SjvO2（仅在 C 组测量）和动脉血二氧化碳分压。
在 C 组中，肿瘤同侧的 Vmca 在麻醉前和拔管后所有时间均明显高于对侧 Vmca。C 组患者在拔管时同侧 Vmca 明显升高（95.7±16.9 cm/s 比 63.7±6.7 cm/s，P<0.01），然后在拔管后 2 小时内下降，但仍明显高于基线。而 A 组右侧 Vmca 变化较小（63.6±7.7 cm/s 比 61.8±8.1 cm/s，P<0.01）。C 组患者在拔管时 SjvO2 明显升高（81.4%±7.4% 比 60.9%±3.7%，P<0.01），且在拔管后 2 小时内仍明显高于基线。在任何时间点，Vmca 与 MAP 之间均无显著相关性。
颅脑肿瘤切除术后会发生脑充血。肿瘤同侧的充血更为明显。
