脉搏灌注变异指数监测在腹腔镜胆囊切除术患者中的应用

Application of pleth variability index monitoring in patients receiving laparoscopic cholecystectomy

目的研究全麻下行腹腔镜胆囊切除术患者脉搏灌注变异指数(PVI)的变化趋势及术前基础PVI值的影响因素。方法选择ASA分级为Ⅰ～Ⅱ级的67例腹腔镜胆囊切除术患者,年龄18～65岁,入室后持续监测患者心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)及脉搏血氧饱和度(SpO2),利用Masimo(Radical-7,USA)监测灌注指数(PI)及PVI值的变化。麻醉诱导前快速输注平衡液10mL/kg,诱导后均以丙泊酚复合瑞芬太尼静脉全麻。结果患者平均基础PVI值为(16.8±6.3)%,全麻诱导后PVI下降至(10.3±5.4)%,气腹建立后又升至(21.2±9.5)%。年龄<45岁的患者术前基础PVI值高于≥45岁的患者[(19.2±6.5)%vs(15.5±5.9)%,P<0.05];男性患者术前基础PVI值高于女性患者[(18.8±7.5)%vs(15.35±4.8)%,P<0.05];体质量指数(BMI)与术前基础PVI没有显著关联。结论患者入室平均PVI高于14%,提示存在容量不足。年龄因素和性别因素均与术前基础PVI值相关,即男性和年龄<45岁的患者术前基础PVI值更高。

Objective To study the changes of pleth variability index （PVI） in patients receiving laparoscopic cholecystectomy under general anesthesia, and to investigate the clinical influencing factors of pre-operation baseline PVI value. Methods Totally 67 patients undergoing laparoscopic cholecystectomy with ASA Ⅰ-Ⅱ, aged 18 to 65 years old, were included in the present study. The heart rate （HR）, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, mean arterial pressure （MAP）, pulse oximetry （SpO2）, perfusion index （PI）, and PVI value were monitored with a Masimo pulse oxygen monitor （Radical-7, USA） after entering the operation room. Fluid expansion with 10 mL/kg of balanced solution was given before the induction. Anesthesia was maintained under total intravenous anesthesia （TIVA） with propofol and remifentanil. Results The average baseline PVI value was （16.8±6.3）% in the patients; then it decreased to （10.3±5.4）% after induction of anesthesia and increased to （21.2±9.5）% after establishment of pneumoperitoneum. The pre-operation baseline PVI value （／[19.2±6.5／] %） of patients 〈45 years old was significantly higher than that in patients ≥45 years old （／[15.5±5.9／]%, P〈0.05%）. Male patients had a significantly higher PVI （／[18.8±7.5／]%） value than female patients （／[15.3±4.8／]%, P〈0.05）. Body mass index （BMI） was not significantly associated with pre-operation baseline PVI. Conclusion The baseline value of PVI is higher than 14%, suggesting insufficient volume load in most of patients. Age and sex are both associated with pre-operation PVI value： male patients and those 〈45 years old have a higher pre-operation baseline PVI value.