末梢灌注指数在腔镜下胸交感神经切除术中的应用

Application of tip perfusion index in transthoracic endoscopic sympathectomy

目的通过观察胸腔镜下胸交感神经切除前后同侧上肢末梢灌注指数的变化与预后的关系,来评价末梢灌注指数作为胸交感神经成功切除术中监测的可能性。方法10例手汗症患者在半坐位、左侧双腔气管导管插管、静吸复合全麻下行腔镜下胸交感神经切除术,连续监测有创动脉压、心率、手术侧上肢末梢灌注指数和作为对照的下肢末梢灌注指数,并记录两侧胸交感神经切除前及切除后1、2、3、5、10 min的观察指标。结果在切除前后,有创动脉压、心率比较差异无统计学意义(P>0.05);术侧上肢末梢灌注指数切除后与切除前相比,在切除后1 min时差异有统计学意义(P<0.05),在2、3、5、10 min时差异有统计学意义(P<0.01);对照末梢灌注指数在切除前后差异无统计学意义。所有患者症状完全缓解或大部分缓解。结论手术侧上肢末梢灌注指数在胸交感神经成功切除后明显增高,可在术中及时评价胸交感神经的切除情况。

Objective To evaluate feasibility of intraoperative tip perfusion index （TPI） as a monitor of successful thoracic sympathectomy by observing the changes in TPI during peri - sympathectomy. Methods Ten patients with hyperhidrosis underwent bilateral endoscopic thoracic sympathectomy under general anesthesia in semi - fowler position. Hemodynamic variables, SpO2 , TPI were continuously monitored. TPI were monitored by two pulse - oximetry probes placed on operative side hand and lower limb. Data were analyzed with repeated measures analysis of variance and Bonferroni test. Results The TPI in the lower limb ,the hemodynamics, as well as SpO2 remained constant（ P 〉 0.05 ）. The operative side TPI had a significant difference at 1 minute after the transaction of sympathetic chain compared with before it （ P 〈 0.05 ） , and had a very significant difference at 2, 3, 5, 10 minutes after the procedure（ P 〈 0.01 ）. All patients responded that their symptoms were either completely resolved, or mostly resolved. Conclusion TPI increased immediately after the successful thoracic sympathectomy. It can be used as an additional indicator of successful thoracic sympathectomy.