应用光电容积脉搏波监测小儿腹腔镜疝修补术中伤害性刺激强度变化

Application of photoplethysmography in monitoring changes of noxious stimulation intensity during pediatric laparoscopic hernia repair

目的探讨应用光电容积脉搏波监测小儿腹腔镜疝修补术中气腹针置入引起的伤害性刺激强度变化的可行性。方法将90例美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级、择期接受腹腔镜疝修补术的2~4岁患儿随机分为A、B、C 3组,每组30例。A组于常规全麻诱导气管插管后、放置气腹针前5min接受0.1μg/kg舒芬太尼,B组于全麻诱导气管插管后、放置气腹针后即刻接受0.1μg/kg舒芬太尼,C组全麻诱导气管插管后仅放置气腹针,未接受舒芬太尼。测定并记录3组在置入气腹针前约6 min(A组为接受舒芬太尼前1 min,舒芬太尼注射时间短未计入,记为"T1")、放置气腹针后即刻(T2)以及放置气腹针后(B组为接受舒芬太尼)5min(T3)3个时刻患儿示指处光电容积脉搏波波幅(PPGA)、和腹部肌肉的表面肌电图(sEMG)。结果 A组患儿T1、T2、T3时间点的PPGA差异无统计学意义(P>0.05)。B组患儿T2时间点的PPGA较T1时间点降低(P<0.05),而T3时间点的PPGA较T2时间点增加(P<0.05)。C组患儿T2和T3时间点的PPGA均较T1时间点降低(P<0.05)。3组PPGA均与本组sEMG呈负相关(r=-0.601、-0.512、-0.613,P<0.05)。结论应用光电容积脉搏波可以量化小儿腹腔镜疝修补术中伤害性刺激强度的变化,具有良好的应用价值。

Objective To explore the feasibility of photoplethysmography in monitoring the changes of noxious stimulation intensity caused by veress needle insertion during pediatric laparoscopic hernia repair.Methods Ninety pediatric patients（2-4years old）with the American Society of Anesthesiologists（ASA）grade ofⅠ-Ⅱ scheduled for laparoscopic hernia repair surgery were randomized into three groups（n=30）：group A,B,and C.After tracheal intubation of general anesthesia induction,the pediatric patients in group A received intravenous 0.1μg/kg sufentanil 5min before veress needle insertion,group B received 0.1μg/kg sufentanil immediately after placing the veress needle,while group C received veress needle insertion without sufentanil.The photoplethysmographic amptitude（PPGA）from right forefinger,and surface electromyography（sEMG）of abdominal muscles of pediatric patients were recorded at 6min prior to veress needle insertion（that is 1min before receiving sufentanil in the group A,and the injection time was not included,T1）,immediately after veress needle insertion（T2）,and at 5 min after veress needle insertion（that is5 min after administration of sufentanil in the group B,T3）.Results The values of PPGA had no significant difference between T1,T2 and T3in group A（P〈0.05）.Compared with T1 and T3,the value of PPGA at T2 was significantly decreased in group B（P〈0.05）.The values of PPGA at T2 and T3were significantly decreased compared with T1 in group C（P〈0.05）.PPGA was negatively correlated with sEMG in three groups（r=-0.601,-0.512,-0.613;P〈0.05）.Conclusion Photoplethysmography can quantify the changes of noxious stimulation intensity in pediatric laparoscopic hernia repair and has good application values.