指光电容积脉搏波技术与脑状态指数用于麻醉深度监测的比较

Comparison of finger photoplethysmogram and cerebral state index for monitoring depth of anaesthesia

目的:指端光电容积脉搏波(PPG)与脑状态指数(CSI)用于麻醉深度监测的对比性观察。方法:全麻下行甲状腺或乳腺手术患者93例,气管插管前靶控输注(TCI)异丙酚进行麻醉诱导,靶浓度从0.5mg/L开始,每隔3 min递增0.5 mg/L,直至改良清醒镇静评分(MOAAS)为0后,以原靶浓度继续泵注。持续描记指端PPG,记录CSI,每隔30 s行MOAAS评分。计算脉搏波参数与MOAAS的相关性及各指标预测MOAAS评分的预测概率(Pk)。结果 :麻醉诱导开始至气管插管前,PPGA值在MOAAS 4级至3级、3级至2级时显著上升(P<0.05);CSI值在各相邻MOAAS评分间比较差异均有统计学意义(P<0.05)。PPGA、PBI、CSI与MOAAS的相关系数分别为-0.55、-0.30、0.93,在不同MOAAS评分时的Pk值分别为0.64、0.54、0.93。气管插管及切皮前后PPGA、PBI值比较差异有统计学意义(P<0.05)。结论:麻醉深度监测中,CSI可很好的监测镇静深度,PPGA、PBI可较好地反映全身麻醉下伤害性感受反应,故PPGA结合CSI可完善麻醉深度的监测。

Objective To explore the similarities and differences between finger photoplethysmogram （PPG） and CSI in monitoring the depth of anaesthesia in Chinese adults under general anaesthesia. Methods Ninety-three patients, ASA I or 1I , aged 20-67, under general anaesthesia were enrolled. Anaesthesia was induced with target-controlled infusion （TCI） of propofol. The initial TCI concentration of propofol was set at 0.5 mg-L-1 followed by increments of 0.5 mg.L-1 at 3-min interval until the score of Modified Observer＇s Assessment of Alertness/Sedation Scale （MOAAS）reaehed 0. PPG and CSI were continuously monitored and their values were recorded every 2-4 seconds. MOAAS was recorded every 30 seconds to evaluate the sedation level in the study period. ResultsFor the periodfrom pre-induetion to pre-intubation, the difference of photoplethysmogTam amplitudevalues had statistical significance between level 4 and level 3, level 3 and level 2 of MOAAS （P〈 0.05）. CSIvalues declined along with the decrease of MOAAS levels and were statistically different between every two neighboring levels of MOAAS（P 〈 0.05）. Photoplethysmogram amplitude （PPGA） and pulse beat interval （PBI） values showed significant differences before and after intubation, pre- and post-incision （P 〈 0.05）. Conclusions PPGA and PBI appear to be suitable to monitor the nocieeptive component of balanced general anesthesia, while the CSI exhibits a good performance in monitoring the sedation or hypnotic component of balanced general anesthesia, thusthe combination of PPGA and CSI would benefit the monitoring of the adequacy of depth of anaesthesia.