老年患者全麻期间颈总动脉血流的动态变化及其生理调控机制：一项前瞻性研究

doi:10.12122/j.issn.1673-4254.2026.04.05

摘要/Abstract

摘要：

目的颈动脉血流减少与围术期脑血管及神经系统并发症密切相关，但其在全身麻醉期间的变化规律及生理调控因素仍缺乏系统认识。方法前瞻性纳入193例接受腹部手术的老年患者，连续记录围术期呼吸、循环参数及麻醉深度指标。采用矢量血流成像技术在多个关键时间点测量颈总动脉（CCA）血流量。将心率、平均动脉压、呼气末二氧化碳及双频指数纳入线性混合效应模型，并以患者作为随机效应，分析并解释术中CCA血流变化的生理决定因素。结果老年患者在全身麻醉期间CCA血流呈现明显的阶段性波动。线性混合效应模型可解释术中CCA血流变异的52.0%（调整后R²=0.520，P<0.001）。心率、平均动脉压、呼气末二氧化碳及双频指数均与颈动脉血流变化显著相关（P<0.001）。标准化模型进一步显示，不同生理指标对CCA血流的调节强度存在明显差异，其中血流动力学相关指标的影响高于血压或心率变化。手术方式及手术体位对颈动脉血流无显著影响。结论本研究从整体生理调控角度表明，术中脑灌注并非单纯依赖血压维持，而是受到通气水平、循环状态及麻醉深度的协同调控。有效识别和管理相关影响因素有助于优化术中脑灌注。

关键词: 颈总动脉血流量, 脑灌注, 矢量血流成像, 老年患者, 全身麻醉

Abstract:

Objective To explore the dynamic pattern and physiological regulation of common carotid artery (CCA) blood flow during general anesthesia in elderly patients. Methods A total of 193 elderly patients undergoing abdominal surgery were prospectively enrolled. Respiratory and hemodynamic variables and anesthetic depth of the patients were recorded throughout the perioperative period. CCA blood flow was measured at predefined time points using vector flow imaging. Heart rate, mean arterial pressure, end-tidal carbon dioxide, and bispectral index were included in a linear mixed-effects model, with patient ID as a random effect, to explore the physiological determinants of intraoperative CCA blood flow. Results CCA blood flow showed clear stage-related changes during general anesthesia. The mixed-effects model explained 52.0% of the variation in CCA blood flow (adjusted R²=0.520, P<0.001). Heart rate, mean arterial pressure, end-tidal carbon dioxide, and bispectral index were all significantly associated with CCA blood flow (all P<0.001). The standardized model further showed that the strength of these associations differed, with flow-related factors showing a stronger effect than blood pressure or heart rate alone. Surgical approach and patient position had no significant effect on CCA blood flow. Conclusion Intraoperative cerebral perfusion is not maintained by blood pressure alone but influenced jointly by ventilation, hemodynamic status, and anesthetic depth. Recognizing and managing these factors may help optimize cerebral perfusion during surgery.

Key words: common carotid artery blood flow, cerebral perfusion, vector flow imaging, elderly patients, general anesthesia

刘星扬, 吴静涵, 叶春艳, 王锷, 胡浩. 老年患者全麻期间颈总动脉血流的动态变化及其生理调控机制：一项前瞻性研究[J]. 南方医科大学学报, 2026, 46(4): 761-769.

Xingyang LIU, Jinghan WU, Chunyan YE, E WANG, Hao HU. Dynamic changes and physiological regulation of common carotid artery blood flow during general anesthesia in elderly patients: a prospective study[J]. Journal of Southern Medical University, 2026, 46(4): 761-769.

图/表 8

表1 受试者基线特征

Tab.1 Baseline characteristics of the enrolled patients (n=193)

Variable	Parameter
Age (year)	69.28±3.71
Male [n (%)]	102.00 (52.85)
BMI (kg/m²)	22.64±2.99
ASA physical status [n (%)]
II	62.00 (32.12)
III	131.00 (67.88)
Complication [n (%)]
Hypertension	77.00 (39.90)
Diabetes	31.00 (16.06)
Coronary heart disease	12.00 (6.22)
Smoking history [n (%)]	64.00 (33.16)
Alcohol use history [n (%)]	48.00 (24.87)
Operative site [n (%)]
Stomach	47.00 (24.35)
Colon	86.00 (44.56)
Rectal	48.00 (24.87)
Other	12.00 (6.22)
Operative approachs [n (%)]
Laparotomy	35.00 (18.13)
Laparoscopy	158.00 (81.87)

表2 围术期颈总动脉（CCA）血流及常规监测指标的变化

Tab.2 Changes in perioperative common carotid artery （CCA） blood flow and routine monitoring indicators (n=193)

Variable	Awake (T1)	After induction of anaesthesia (T2)	5 min after surgery started (T3)	At the end of the surgery (T4)
CCA blood flow (mL/min) ^a	319.45 (274.66-367.55)	242.10 (195.05-306.30)	228.90 (175.10-301.55)	224.80 (179.45-276.80)
CCA PSV (cm/s)^b	55.02±10.15	51.03±11.01	44.59±10.52	45.17±9.43
MAP (mmHg)^b	92.44±15.35	79.76±14.54	89.20±10.93	82.97±9.28
SBP (mmHg)^b	136.53±18.19	116.32±22.67	129.74±17.10	124.19±14.58
HR (beat/min)^a	73.00 (67.00-81.00)	62.00 (57.50-68.00)	61.00 (56.00-67.00)	59.00 (55.00-64.00)
BIS^a	95.00 (93.00-97.00)	47.00 (42.00-53.00)	42.00 (39.00-46.00)	48.00 (44.00-52.0)
ETCO₂ (mmHg)^b	30.48±5.21^c	33.73±3.81	34.18±4.09	32.55±4.02

图1 流程图

Fig.1 Flow chart of patient enrollment. ETCO2: End-tidal carbon dioxide.

图2 围术期颈总动脉(CCA)血流及常规监测指标的变化

Fig.2 Perioperative changes in CCA blood flow and routine monitoring indicators (n=193). A: CCA blood flow; B: Peak systolic velocity (PSV); C: Mean arterial pressure (MAP); D: Systolic blood pressure (SBP); E: Heart rate (HR); F: Bispectral index (BIS); G: End-tidal carbon dioxide (ETCO2). All variables were measured at awake supine state (T1), 5 min after induction of anesthesia (T2), 5 min after the start of surgery (T3), and at the end of surgery(T4). H: Change in CCA blood flow between the awake state (T1) and the intraoperative mean value. The intraoperative mean CCA blood flow was calculated as the average of measurements taken every 10 min during surgery. I: Change in CCA blood flow between the awake state (T1) and the intraoperative minimum value. In A-G, the overall time effect was assessed using repeated-measures ANOVA, and the corresponding P value was presented in the lower left corner of each figure. Pairwise comparisons between time points were conducted within the same analytical framework using Tukey's adjustment for multiple comparisons. *P<0.05, ***P<0.001 vs T1; #P<0.05, ###P<0.001 vs T2; ++P<0.01, +++P<0.001 vs T3. In H and I.

图3 不同手术方式及体位下术中多个时间点的CCA血流变化

Fig.3 Changes in intraoperative CCA blood flow at multiple time points under different surgical approaches and patient positions. A, B: Operative approaches included laparoscopy (n=158) and laparotomy (n=35). The time points recorded were as follows: (t1) preoperative awake state; (t2) 5 min after surgery started; (t3) 30 min after surgery started; (t4) 60 min after surgery started; (t5) 90 min after surgery started; (t6) 120 min after surgery started; and (t7) at the end of the surgery. C, D: Operation position included Trendelenburg (n=110), reverse Trendelenburg (n=48), and horizontal (n=35). The time points recorded were as follows: (t1) before the change in position; (t2) 5 min after the postural change; (t3) 10 min after the postural change; (t4) 20 min after the postural change; (t5) 30 min after the postural change; and (t6) 60 min after the postural change.

图4 混合线性模型森林图: 不同生理指标对CCA血流的影响

Fig.4 Forest plots of the linear mixed-effects models showing the effects of physiological variables on CCA blood flow. A: Model constructed using original measurement scales, illustrating the change in CCA blood flow per unit increase of each variable. B: Model constructed with Z-score-standardized predictors, allowing comparison of the relative strength of effects among variables. Data from 193 patients at 3 intraoperative time points were included (T2: after induction of anesthesia; T3: 5 min after surgery started; T4: at the end of surgery).

图5 不同手术阶段各生理指标对CCA血流影响的混合效应模型预测曲线

Fig.5 Changes in intraoperative CCA blood flow at multiple time points under different surgical approaches and patient positions. The x-axis shows standardized values (Z-scores) of physiological variables, and the y-axis shows predicted CCA blood flow. Shaded areas represent 95% confidence intervals, with dashed lines indicating the boundaries. Only PSV shows a visibly reduced slope during surgical initiation (T3), which returns to a pattern similar to T2 and T4, indicating a phase-specific effect of PSV on carotid blood flow. Other variables show nearly parallel slopes across phases, suggesting no significant interaction with time.

表3 各生理指标与手术阶段（T3）交互项的线性混合效应模型结果

Tab.3 Interaction terms between physiological variables and surgical phase (T3) in the mixed-effects model

Variable	β	95% CI	P
PSV	-2.867	-3.80 to -1.93	<0.001
MAP	0.206	-0.60 to 1.01	0.618
HR	-0.212	-1.24 to 0.82	0.685
BIS	-0.686	-1.84 to 0.47	0.244
ETCO₂	2.076	-0.35 to 4.50	0.094

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