指端光电容积脉搏波在循环功能动态监测中的意义

Significance of finger tip photoplethysmography volume pulse wave in dynamic monitoring of circulatory function

目的探讨指端光电容积脉搏波在循环功能动态监测中的意义。方法择期骨伤科手术治疗患者110例,其中男性69例,女性41例;年龄29～69岁。麻醉手术期间动态记录容积脉搏波变化,提取波峰形态和血流曲线上Y1、Y2、Y33个特征参数,观察并分析其变化规律。结果波形分为两类,主波峰Y1大致归为5种形态:锐锋1、锐锋2、前钝后锐峰、钝圆峰、前锐后钝峰,其动态变化与小动脉和微动脉的紧张性和弹性直接相关。Y1、Y2、Y33个特征参数值的动态变化在一定范围内与失血量及失血速度密切相关。结论①分析指端光电容积脉搏波峰形动态变化有助于评估人体小动脉和微动脉血管紧张性和弹性,监测微循环血流灌注变化。②分析Y1、Y2、Y33个特征参数值的动态变化有助于及时发现微循环血流灌注量减少,早期预测失血性休克的发生、发展,指导临床液体复苏治疗。

Objective To study the significance of fingertip photoplethysmography in dynamic monitoring of circulatory function.Methods A total of 110 cases of ASA Ⅰ-Ⅱ patients（male 69,female 41;aged 29-69 years） scheduled for orthopaedic trauma surgery were enrolled.The patients＇ fingertip volume pulse wave were dynamically recorded during anesthesia.Peak shape and three characteristic parameters（Y1,Y2,Y3） were extracted from the pulse waves.Their variations were observed and analyzed.Results The mainpeak form was broadly classified as 5 types of shape（sharp peak 1,sharp peak 2,blunt and sharp peak,blunt round peak,sharp and blunt peak）.Their transformation was directly related to tension and elasticity of the small arteries and arteriole.Three characteristic parameters（Y1,Y2,Y3） were directly related to hemorrhage volume and velocity.Conclusion ① The main peak form can be used to evaluate vascular tone and elasticity of the small arteries and arteriole,and to monitor the microcirculation blood flow.② Three characteristic parameters（Y1,Y2,Y3） and the relationship among them are helpful to predict hemorrhagic shock and guide to fluid resuscitation.