俯卧位对脊柱手术患者经颅多普勒评估的脑血流动力学和无创颅内压的影响：一项前瞻性观察研究。

Effect of prone position on cerebral hemodynamics and noninvasive intracranial pressure assessed using transcranial Doppler in patients undergoing spine surgeries: a prospective observational study.

作者信息

Taj Yaseen, Samagh Navneh, Paliwal Shashank Umesh, Ganesh Venkata, Dey Ankita, Aggarwal Varun

机构信息

Department of Anaesthesiology, All India Institute of Medical Sciences, 1st Floor, IPD Block, Bathinda, Punjab, 151001, India.

Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.

出版信息

BMC Anesthesiol. 2025 May 15;25(1):242. doi: 10.1186/s12871-025-03116-9.

DOI:10.1186/s12871-025-03116-9

PMID:40375147

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12079893/

Abstract

BACKGROUND

The prone position, frequently used in spine surgeries for optimal surgical access, induces physiological changes in cardiovascular and respiratory parameters. Increased intraabdominal and intrathoracic pressures lead to elevated central venous pressure (CVP). Along with raised intrathoracic pressure, positive end-expiratory pressure (PEEP) results in elevated CVP, impeding venous blood flow from the brain and potentially affecting intracranial pressure (ICP). Transcranial Doppler (TCD) ultrasound is a non-invasive method commonly used to measure cerebral hemodynamic parameters, including peak systolic velocity (PSV/ MCAv), mean flow velocity (MFV/MCAv), pulsatility index (PI) and resistivity index (RI), which are associated with cerebral vascular resistance, intracranial pressure, and cerebral perfusion pressure (CPP).

METHOD

Thirty-three patients undergoing spine surgery were assessed. The vital and TCD parameters PSV/MCAv, MFV/MCAv, PI, and RI were noted in the supine position. (T). General anaesthesia was administered, and TCD measurements were repeated after induction. (T). Patients were then positioned prone, and TCD measurements were repeated at intervals T - immediately after the prone position, T -15 min of the prone position, T -30 min, T -45 min and T - 60 min. Vital parameters were noted at the above-mentioned time points. Non-invasive ICP (nICP) was calculated.

RESULTS

There was a statistically significant decrease in the heart rate (HR) compared to the supine position at T and T as compared to T. There was a statistically significant decrease in systolic blood pressure (SBP) as compared to T at T (p < 0.001), T (p < 0.001), T (p = 0.003), T (p = 0.001), and T (p = 0.018). The study found no statistically significant changes in cerebral hemodynamic parameters (PSV/MCAv, MFV/MCAv PI and RI) and nICP at various time points.

CONCLUSION

Our findings suggest that the prone position does not cause significant changes in cerebral hemodynamics and nICP.

TRIAL REGISTRATION

CTRI/2023/06/053677 dated 08/06/2023.

摘要

背景

俯卧位常用于脊柱手术以获得最佳手术入路，会引起心血管和呼吸参数的生理变化。腹内压和胸内压升高导致中心静脉压（CVP）升高。呼气末正压（PEEP）与升高的胸内压一起导致CVP升高，阻碍静脉血从脑部流出，并可能影响颅内压（ICP）。经颅多普勒（TCD）超声是一种常用的非侵入性方法，用于测量脑血流动力学参数，包括收缩期峰值流速（PSV/MCAv）、平均流速（MFV/MCAv）、搏动指数（PI）和阻力指数（RI），这些参数与脑血管阻力、颅内压和脑灌注压（CPP）相关。

方法

对33例接受脊柱手术的患者进行评估。记录仰卧位时的生命体征和TCD参数PSV/MCAv、MFV/MCAv、PI和RI。（T）。实施全身麻醉，并在诱导后重复进行TCD测量。（T）。然后将患者置于俯卧位，并在俯卧位后立即、俯卧位15分钟、30分钟、45分钟和60分钟间隔重复进行TCD测量。在上述时间点记录生命体征参数。计算无创颅内压（nICP）。

结果

与仰卧位的T相比，T和T时心率（HR）有统计学意义的下降。与T时相比，T（p < 0.001）、T（p < 0.001）、T（p = 0.003）、T（p = 0.001）和T（p = 0.018）时收缩压（SBP）有统计学意义的下降。研究发现，在各个时间点，脑血流动力学参数（PSV/MCAv、MFV/MCAv、PI和RI）和nICP没有统计学意义的变化。