| Objective:To study the impact of Transcranial color Doppler ultrasound(TCD)in monitoring cerebral blood flow system in guiding individual blood pressure control in Carotid endarterectomy(CEA),aim to find a blood pressure management method to reduce myocardial oxygen consumption under the premise of ensuring cerebral blood flow supply.Methods:Selecte 30 patients(20 males and 10 females)with carotid endarterectomy,the ASA(American Society of Anesthesiologists)level II to III,ranging from 45 to 65 years old,and 50 to 80 kg weight,randomly divided into the experimental group E(n=15)and the control group C(n=15).Patients are examined ECG,SPO2,BP and BIS routinely,monitoring the depth of anesthesia,anesthesia partiy and tube into the down radial artery and continuous monitoring of invasive arterial pressure.Using TCD to monitor the mean blood flow velocity of the middle cerebral artery continually.Prepare vasoactive drugs norepinephrine and nitroglycerin for blood pressure adjustment during operation.Adjust the respiratory parameters,and maintainthe end-tidal partialpressure of carbon dioxide(PETCO2)between 35 and45 mm Hg.BIS was used to monitor the depth of anesthesia,and maintain the number of eeg between 40 and 60.Blood pressure adjustment: group C elevate blood pressure 20 to 30% of the basic values 5 minutes before the carotid artery clip,if cerebral blood flow is still not in safe range(not less than 70% before the clip)continues to raise blood pressure or communication with the surgeon whether place flow pipe,reduce the blood pressure by about 10% after the clip,if cerebral blood flow is still not in safe range(not more than 100% before the clip)continued to lower blood pressure.Group E adjusted blood pressure according to TCD cerebral blood flow parameters after the clamping,so that the cerebral blood flow after the clamping was not lower than 70% before the clamping,and the cerebral blood flow after the opening was not higher than 100% before the clamping.Record before anesthesia(T00),10 minutes after anesthesia(T0),5minutes before the clip(T1),immediately after the clip(T2),immediately after opening(T3),1 hour after opening(T4),middle cerebral artery blood flow velocity Vm and peripheral artery systolic pressure BP,record the average heart rate and myocardial oxygen consumption during the clip(systolic pressure*heart rate),recording moving tachycardia,bradycardia,hypertension,hypotension,times,records in the two groups patientsthe number of narcoticdrugs and vascular active drug dosage and liquid intake of the two groups patients used in operation,record the carotid artery clip time,operation time,awakening time,anesthesia time,record how many times the cases of cardiovascular occurs.and the MRI results on the first day after surgery were recorded.Results:(1)Comparison of general data between the two groups:There was no significant difference between the two groups in gender composition,age,ASA grade,hypertension,diabetes and other complications,preoperative ecg and echocardiographic abnormalities(P>0.05).(2)Intraoperative data of the two groups were compared:There were no statistically significant differences between the two groups in preoperative stenosis of the opearate side and non-opearate side,time of surgery and anesthesia,carotid artery clipping,anesthetic dose,fluid intake,incidence of intraoperative tachycardia,severe hypertension and hypotension,time of recovery,and cardiovascular complications(P>0.05),There were statistically significant differences between the two groups in bradycardia(P>0.05).(3)Comparison of the changes of Vm and Bp at different time points during the operation:Compared with T00,Vm and BP of the surgical side and non-surgical sideboth decreased at T0 in the two groups,and the difference was statistically significant(P<0.05).Compared with T0,the operative side Vm decreased at T2 and the Vm increased at T3,the difference was statistically significant.The non-operative side Vm increased and reached the peak at T2,and the difference was statistically significant(P<0.05).(4)Comparison of the intraoperative Vm and Bp values at the same time point between the two groups:Compared with group C,group E operation side Vm in T2 time drop is higher,the difference was statistically significant(P< 0.05),lower BP in group E,the difference was statistically significant(P< 0.05)and the average increase was 16.46±6.6 percent.(5)Comparison of the use of vasoactive drugs between the two groups:Compared with group C,the dose of norepinephrine in group E was lower,and the difference was statistically significant(P<0.05),while the dose of nitroglycerin in group E was lower,and the difference was statistically significant(P<0.05).(6)Comparison of myocardial oxygen consumption during occlusion between the two groups:Compared with group C,the myocardial oxygen consumption was lower in group E during carotid artery occlusion,and the difference was statistically significant(P<0.05),and there was no significant difference in heart ratebetween the two groups during the occlusion(P>0.05).Conclusion:Transcranial color ultrasound doppler monitoring system can guide the intraoperative blood pressure control of CEA,and it is more accurate than the traditional blood pressure regulation,can reduce the myocardial oxygen consumption as well. |
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