背景:超快脑多普勒超声能够同时量化和可视化脑血流速度。这项研究的目的是比较麻醉期间常规和超快频谱多普勒的使用及其显示麻醉程序对脑血流速度的影响的潜力。与接受腹股沟疝修补术的婴儿的血压和脑氧合有关。
方法:一项针对6个月以下婴儿的单中心前瞻性观察性队列研究。我们根据麻醉诱导过程中的成功测量次数评估了常规和超快频谱多普勒脑超声测量,七氟醚诱导后,尾部镇痛的给药,液体推注和麻醉的出现。脑血流速度在脑动脉中使用常规频谱多普勒进行定量,在大脑皮层中使用超快多普勒通过峰值收缩期速度进行定量,舒张末期速度和电阻率指数。
结果:20名婴儿在72/100测量中使用了常规频谱多普勒图像,在51/100测量中使用了超快多普勒图像。术中,成功率分别为53/60(88.3%)和41/60(68.3%),分别。脑血流速度增加后出现两种常规(舒张末期速度,从2.01到2.75厘米/秒,p<0.001)和超快频谱多普勒(舒张末期速度,从0.59到0.94厘米/秒),而脑氧合显示出相反的模式,婴儿出现后减少(85%至68%,p<0.001)。
结论:可以使用常规和超快速频谱多普勒脑超声来量化全身麻醉期间的皮质血流速度。脑血流速度和血压下降,而全身麻醉期间局部脑氧合增加。超快频谱多普勒超声为大脑皮层内的灌注提供了新的见解,无法通过传统的频谱超声波。然而,与传统方法相比,超快多普勒的成功率较低,学习曲线更严格。
Ultrafast cerebral Doppler ultrasound enables simultaneous quantification and visualization of cerebral blood flow velocity. The aim of this study is to compare the use of conventional and ultrafast spectral Doppler during anesthesia and their potential to show the effect of anesthesiologic procedures on cerebral blood flow velocities, in relation to blood pressure and cerebral oxygenation in infants undergoing inguinal hernia repair.
A single-center prospective observational cohort study in infants up to six months of age. We evaluated conventional and ultrafast spectral Doppler cerebral ultrasound measurements in terms of number of successful measurements during the induction of anesthesia, after sevoflurane induction, administration of caudal analgesia, a fluid bolus and emergence of anesthesia. Cerebral blood flow velocity was quantified in pial arteries using conventional spectral Doppler and in the cerebral cortex using ultrafast Doppler by peak systolic velocity, end diastolic velocity and resistivity index.
Twenty infants were included with useable conventional spectral Doppler images in 72/100 measurements and ultrafast Doppler images in 51/100 measurements. Intraoperatively, the success rates were 53/60 (88.3%) and 41/60 (68.3%), respectively. Cerebral blood flow velocity increased after emergence for both conventional (end diastolic velocity, from 2.01 to 2.75 cm/s, p < 0.001) and ultrafast spectral Doppler (end diastolic velocity, from 0.59 to 0.94 cm/s), whereas cerebral oxygenation showed a reverse pattern with a decrease after the emergence of the infant (85% to 68%, p < 0.001).
It is possible to quantify cortical blood flow velocity during general anesthesia using conventional and ultrafast spectral Doppler cerebral ultrasound. Cerebral blood flow velocity and blood pressure decreased, while regional cerebral oxygenation increased during general anesthesia. Ultrafast spectral Doppler ultrasound offers novel insights into perfusion within the cerebral cortex, unattainable through conventional spectral ultrasound. Yet, ultrafast Doppler is curtailed by a lower success rate and a more rigorous learning curve compared to conventional method.