Department of Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria.
Department of Anaesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland.
Br J Anaesth. 2017 Mar 1;118(3):400-406. doi: 10.1093/bja/aex001.
Cerebral microemboli (ME) are frequently generated during orthopaedic surgery and may impair cerebral integrity. However, the nature of cerebral ME, being either of solid or gaseous origin, is poorly investigated. Our primary aim was to determine both the frequency and nature of cerebral ME in generally anaesthetised patients undergoing major orthopaedic surgery.
Fifty patients (hip/knee/shoulder prosthesis, spine surgery) were enrolled. Cerebral ME and cerebral blood flow velocity (CBFV) were determined in both middle cerebral arteries for 15 min preoperatively and postoperatively, using transcranial Doppler ultrasound. Cerebral tissue oxygen index, determined by near-infrared spectroscopy, was further examined. Statistical analysis was carried out using the Wilcoxon matched-pairs signed-ranks test (median (25 th ; 75 th percentile), P < 0.05).
Overall the frequency of postoperative cerebral ME rose to 600% of preoperative values. Primarily gaseous ME occurred preoperatively and postoperatively [19 (6; 63) vs 116 (24; 373), P < 0.001], while the number of solid ME was negligibly small [1 (0; 2) vs 2 (0; 6), P < 0.001]. CBFV and cerebral tissue oxygen index remained unaltered bilaterally before and after surgery.
Our findings indicate that cerebral ME considerably increase after major orthopaedic surgery under general anaesthesia. The predominant accumulation of gaseous ME and their preoperative occurrence, suggest that the general anaesthesia and individual patient factors may contribute to the embolic load in addition to orthopaedic surgery.
. NCT02340416.
骨科手术中经常会产生脑微栓子 (ME)，可能损害脑完整性。然而，脑 ME 的性质，即固体或气体起源，研究甚少。我们的主要目的是确定全身麻醉下接受大型骨科手术的患者脑 ME 的频率和性质。
纳入 50 例患者（髋关节/膝关节/肩关节假体、脊柱手术）。使用经颅多普勒超声术在手术前和手术后 15 分钟内分别测量双侧大脑中动脉的脑 ME 和脑血流速度 (CBFV)。进一步检查近红外光谱测定的脑组织氧指数。采用 Wilcoxon 配对符号秩检验（中位数 (25 分位数；75 分位数)，P < 0.05）进行统计学分析。
总体而言，术后脑 ME 的频率增加到术前的 600%。主要是术前和术后出现气体性 ME [19 (6; 63) 比 116 (24; 373)，P < 0.001]，而固体性 ME 的数量则微不足道 [1 (0; 2) 比 2 (0; 6)，P < 0.001]。手术前后双侧 CBFV 和脑组织氧指数均保持不变。
我们的发现表明全身麻醉下进行大型骨科手术后脑 ME 明显增加。主要是气体性 ME 的大量积聚及其术前发生提示全身麻醉和个体患者因素除了骨科手术外，还可能导致栓塞负荷增加。
. NCT02340416。
