苏醒期瞳孔大小预测全身麻醉下妇科腹腔镜手术患者术后早期低氧血症的可行性

Feasibility of the Diameter of Pupils during Recovery Period for Predicting Early Postoperative Hypoxemia of Patients Undergoing Gynecological Laparoscopy with General Anesthesia

目的：研究全身麻醉下行妇科腹腔镜手术患者苏醒期瞳孔大小预测术后早期低氧血症的可行性。方法：选择2013年10月—12月美国麻醉医师协会（American Society of Anesthesiologists,ASA）分级Ⅰ-Ⅱ级在全身麻醉下行择期妇科腹腔镜手术的成年女性患者70例。手术均在全凭静脉麻醉下实施。在患者入麻醉后恢复室（postanesthesia care unit,PACU）时记录瞳孔的大小,根据瞳孔大小将患者分为2组：A组（瞳孔直径〈2 mm）和B组（瞳孔直径≥2 mm）,比较2组以鼻导管吸入3L/min氧气状态下即刻（0min）和2、4、6、8、10、20、30 min时的脉搏血氧饱和度（pulse oxygenation saturation,SpO2）值。结果：入PACU后2 min和4 min时,A组患者SpO2值明显低于B组,6 min后差异无统计学意义;入PACU时瞳孔越小,2 min后SpO2数值越低,两者呈线性相关（r2=0.4268）;通过瞳孔大小预测入PACU后10 min内,SpO2最低值的受试者工作特征曲线下面积为0.99,表明瞳孔大小预测术后低氧血症的准确性非常高,最佳的判断阈值为2.25 mm,其预测术后低氧血症的灵敏度为91.4%,特异度为100%。结论：苏醒期瞳孔大小与全身麻醉术后早期低氧血症的发生密切相关,入PACU时通过检查瞳孔大小可以对有呼吸抑制倾向的患者加强监护。

Objective：To explore the feasibility of the diameter of pupils during recovery period for predicting early postoperative hypoxemia of patients undergoing gynecological laparoscopy with general anesthesia.Methods：A total of 70 adult female patients classified as I-II according to American Society of Anesthesiologists（ASA）Criteria,who underwent gynecological laparoscopy during Oct 2013 and Dec 2013,were chosen.The operations were performed with total intravenous anesthesia.The diameter of pupils upon arriving at postanesthesia care unit（PACU）.Patients were divided into two groups,the group A（diameter of pupil was2 mm）and the group B（diameter of pupil was≥2 mm）.The pulse oxygenation saturation（SpO2）immediately after inserting nasal catheter and 2,4,6,8,10,20,30 min after administering 3 L/min oxygen inhalation through nasal catheter,were compared.Results：The value of SpO2 in group A was significantly lower than that in group B at 2 min and 4min after arriving at PACU,however,the difference between two groups was not statistically significant at 6 min after arriving at PACU.The smaller the diameter of pupil on arriving at PACU was,the lower the value of SpO2 at 2 min after arriving was,and there was a linear correlation between the two factors（r2=0.4268）.The area under receiver operator characteristic of the diameter of pupil for predicting the lowest value of SpO2 at 10 min after arriving at PACU was 0.99.It showed a very high accuracy of the diameter of pupil for predicting postoperative hypoxemia.The threshold of the diameter of pupil for evaluation was 2.25 mm.Its sensibility for predicting postoperative hypoxemia was 91.4%,and its specificity was 100%.Conclusions：The diameter of pupils during recovery period was correlated with the occurrence of early hypoxemia after general anesthesia.By checking the diameter of pupils upon arriving at PACU,the monitoring on patients with sign of respiratory depression could be strengthened.