手术体积描记指数及熵指数用于肥胖患者伤害性刺激监测的可行性分析

Feasibility studies of surgical plethysmography index and entropy index in monitoring nociceptive stimulus in obese patients

目的比较麻醉状态下肥胖患者手术体积描记指数(SPI)、熵指数[包括反应熵(SE)及状态熵(RE)]对伤害性刺激的反应能力。方法前瞻性选取首都医科大学附属北京友谊医院2019年5~12月40例肥胖患者择期行胃减容手术常规诱导下气管内插管全身麻醉,记录插管前1 min、插管即刻、插管后2 min,切皮前1 min、切皮即刻、切皮后2 min,拔管前1 min、拔管即刻、拔管后2 min各时间点所对应的SPI、RE、SE数值以及心率(HR)、平均动脉压(MAP)。结果气管插管、切皮、拔管即刻SPI、RE、SE、HR、MAP数值较刺激前均升高,SPI在插管前(37.4±12.00)与插管即刻(54.1±15.60)比较差异具有统计学意义(P<0.05)。SPI在切皮前(29.17±8.82)与切皮即刻(57.71±17.64)比较差异具有统计学意义(P<0.05)。HR在插管前(83.7±12.6 bpm)与插管即刻(94.7±15.0 bpm)比较差异具有统计学意义(P<0.05),在切皮前(69.27±7.64 bpm)与切皮即刻(70.16±10.76 bpm)比较差异具有统计学意义(P<0.05),拔管前(80.7±16.35 bpm)与拔管即刻(91.3±15.9 bpm)比较差异具有统计学意义(P<0.05)。结论 SPI和心率在肥胖患者对伤害性刺激强度有一定的预测作用,均能在一定程度上反映伤害性刺激,其中相比于RE、SE,SPI升高更明显、更快速,具有较好的临床指导作用。

Objective To evaluate the feasibility of surgical plethysmography index(SPI) and entropy index,including state entropy(SE) and response entropy(RE) in response to nociceptive stimulus under general anesthesia.Methods This study prospectively studied 40 obese patients undergoing selective gastric volume reduction surgery under general anesthesia in Beijing friendship hospital,capital medical university,from May to December 2019.SPI,RE,SE,heart rate(HR),mean arterial pressure(MAP) were recorded at 1 minute before,the immediate time and 2 minutes after intubation,skin incision and extubation.Results The values of SPI,RE,SE,HR and MAP at the time of endotracheal intubation,incision and extubation were higher than those before the stimulus.The difference between SPI before intubation 37.4 ± 12.00 and at the time of intubation 54.1 ± 15.60 was statistically significant(P< 0.05).The difference between SPI before incision 29.17 ± 8.82 and at the time of incision 57.71 ± 17.64 was statistically significant(P< 0.05).The difference between HR before intubation(83.7 ± 12.6 bpm)and at the time of intubation(94.7 ± 15.0 bpm) was statistically significant(P< 0.05),the difference between HR before incision(69.27 ±7.64 bpm) and at the time of incision(70.16 ± 10.76 bpm) was statistically significant(P< 0.05),and the difference between HR before extubation(80.7 ± 16.35 bpm) and at the time of extubation(91.3 ± 15.9 bpm) was statistically significant(P< 0.05).Conclusion SPI and HR can predict the intensity of nociceptive stimulus in obese patients to a certain extent.Compared with RE and SE,SPI has a better clinical guidance because SPI is elevated more markedly and rapidly.