清醒镇静对非应激状态下指光电容积脉搏波的影响

The Effect of Intervention by Conscious Sedation on the Finger Photoplethysmogram in Pre-operation

目的：观察清醒镇静效应对非应激状态下指光电容积脉搏波（ FPPG ）的影响，探讨光电容积脉搏波与患者镇静状态之间的关系。方法选择拟在全麻下行甲状腺或乳腺择期手术的患者80例，ASAⅠ或Ⅱ级，依据盐酸右美托咪定的使用剂量随机分为4组（D1，D2，D3，C组），记录患者入室后10min（T0）、给药后10min （T1），15min（T2），20min（T3），25min（T4），30min（T5）各时点的Ramsay镇静评分，并采集患者FPPG信号，各时点描记脉搏波形30s，数据进行离线分析。结果①与T0比较，D1组、D2组和D3组3组患者T1～T5 Ramsay评分均明显升高（P＜0．05）；与T3比较，T4和T5时D3组无统计学差异；与T4比较，T5时D1组、D2组Ramsay评分无差异。同一时点比较D3组Ramsay镇静评分最高，D2组次之，D1组最低；D1组、D2组和D3组Ramsay评分明显高于C组（P＜0．05）。②与T0比较，D1组、D2组和D3组T1～T5 PPGA明显升高（P＜0．05），C组PPGA无差异；与T4比较，T5时D1组、D2组、D3组和C组4组PPGA无差异（P＞0．05）。与C组比较，T1～T5时D1组、D2组和D3组PPGA均明显升高。③Pearson相关性分析：D1，D2，D3组PPGA分别与Ramsay镇静评分呈正相关（ r＝0．493，r＝0．724，r＝0．379，P＜0．01）。结论清醒镇静下，光电容积脉搏波波幅呈现规律性变化。随着Ramsay镇静评分逐级增高，光电容积脉搏波波幅逐渐增大，两者呈正相关；当镇静强度无显著差异时，光电容积脉搏波波幅无显著变化。

Objective To investigate the sedative effect of different doses of dexmedetomidine on the finger photoplethysmogram in pre-operation,and to discuss the relationship between the status of sedation and finger photoplethysmogram（ FPPG） .Methods Eighty pa-tients,ASAⅠ~Ⅱ,undergoing thyroid or breast operation under general anesthesia were randomly divided into four groups according to the different doses of dexmedetomidine（n=80）.The four groups were group D1 （0.4 μg/kg DEX）,group D2 （0.6μg/kg DEX）,group D3 （0. 8μg/kg DEX）,group C（Control group,normal saline）.Ramsay sedation scale were recorded at the time of infusion of dexmedetomidine or saline by 10 minutes（T1）,by 15 minutes（T2）,by 20minutes（T3）,by 25minutes（T4）,by 30 minutes（T5） ,and FPPG signals were recorded non-invasively from right index finger of patients at each point for offline analysis.Results ①Compared with T0 ,Ramsay score was higher at T1 ~T5 in group D1,D2,D3（P〈0.05）.Compared with T3,there was no obvious significant difference at the time of T4,T5 in group D3.Com-pared with T4 ,there was no obvious significant difference at the time of T5 in both group D1 and group D2 .Comparison between groups：At the same time point,Ramsay score was highest in group D3 ,next was group D2 ,group D1 was the last one.Compared with group C,Ramsay score was elevated at all time points in group D1,D2,D3（P〈0.05）②Compared with T0,PPGA score increased at T1 ~T5 in group D1,D2,D3（P〈0.05）,there was no obvious significant difference in group C（P〈0.05）.Compared with T4,there was no obvious significant difference at the time of T5 in group D1 ,D2 ,D3 ,C.Compared with group C,PPGA score was elevated at the time of T1 ~T5 in group D1 ,D2 ,D3 （ P〈0. 05）.③PPGA In group D1,D2,D3 displayed positive relationship to Ramsay sedation scale.Conclusion Under conscious sedation,finger photoplethysmography shows regular changes.With the increase of dose,Ramsay sedation scores increases step by step,and PPGA increases correspondingly,these changes show positively correlated relationship;No significant difference in the sedation strength,no change showed in PPGA.