手术体积描记指数在心脏瓣膜置换手术麻醉诱导过程中对镇痛深度的监测

Application of Surgical Pleth Index in Analgesic Depth Monitoring during Anesthesia Induction in Cardiac Valve Replacement Surgery

目的探讨手术体积描记指数(SPI)与平均动脉血压(MAP)、心率(HR)、心脏指数(CI)、每搏输出量变异度(SVV)及阿片类药物用量的相关性,评价SPI在心脏瓣膜置换手术麻醉诱导过程中的应用价值。方法采用前瞻性双盲随机对照方法,选取2018年6月至2019年6月在苏州大学附属第一医院择期行心脏瓣膜置换手术的患者60例,采用随机数字表法分为传统组(C组,n=30)和SPI组(S组,n=30)。两组均采用静脉麻醉诱导,传统组依据心率、血压变化经验性予以阿片类药物舒芬太尼,SPI组依据SPI指导舒芬太尼用药,维持SPI在30~50,10 s以上。观察两组患者入室后(T0)、诱导后1 min(T1)、诱导后3 min(T2)、插管前即刻(T3)、插管后即刻(T4)、插管后1 min(T5)、插管后3 min(T6)的SPI、HR、MAP、脑电双频指数(BIS)、CI、SVV等数据。记录两组患者一般资料、诱导时间、舒芬太尼用量、血管活性药物使用情况,并比较两组患者循环稳定情况。结果与C组相比,S组舒芬太尼用量大、诱导时间长(均P<0.05)。组内比较:与T0时点相比,S组其它各时点SVV均无明显差别(均P>0.05);C组T2、T3、T4时点SVV明显升高(均P<0.05)。与T3时点相比,S组HR无明显差别(P>0.05);C组T4点HR明显升高(P<0.05);S组T4时点SVV明显升高(P<0.05),C组T4、T5、T6时点SVV明显降低(均P<0.05)。组间比较:与C组相比,S组T3时点MAP明显降低(P<0.05),T4、T5、T6时点HR明显降低(均P<0.05),T3、T4、T5时点CI明显增高(均P<0.05),T2、T3、T4、T5、T6时点SVV明显降低(均P<0.05)。与C组相比,S组的ΔMAP T4-T3、ΔMAP T0-T4,ΔHR T0-T3、ΔHR T4-T3、ΔHR T0-T4,ΔSVV T0-T3、ΔSVV T4-T3、ΔSVV T0-T4差异有统计学意义(均P<0.05)。结论在行心脏瓣膜置换术的患者全麻诱导期间,以SPI为靶向目标调整镇痛药物使用剂量,可以使诱导过程中血流动力学更平稳,血压心率波动更小,提高患者麻醉诱导过程的安全性,指导临床合理用药。

Objective To investigate the correlation between surgical pleth index(SPI)and mean arterial blood pressure(MAP),heart rate(HR),cardiac index(CI),stroke volume variability(SVV)and opioid dosage,and to evaluate the application value of plethysmography index in the induction of anesthesia during cardiac valve replacement surgery.Methods This experiment is a prospective,double-blind,randomized controlled study.Sixty patients undergoing cardiac valve replacement surgery under general anesthesia at the First Affiliated Hospital of Soochow University from June 2018 to June 2019 were selected and divided into the traditional group(group C,n=30)and SPI group(group S,n=30)by using random number table method.The traditional group was given sufentanil empirically based on changes in heart rate and blood pressure,and the SPI group was given sufentanil according to SPI guidance,maintaining SPI at 30-50,for more than 10 s.SPI,HR,MAP,BIS,CI,SVV and other data of patients in the two groups were observed after admission(T0),1 min after induction(T1),3 min after induction(T2),immediately before intubation(T3),immediately after intubation(T4),1 min after intubation(T5),and 3 min after intubation(T6).The general information,induction time,amount of sufentanil,and the use of vasoactive drugs in the two groups were recorded,and the circulatory stability of the two groups was compared.Results Compared with group C,the amount of sufentanil in group S was larger and the induction time was longer(all P<0.05).Comparison within the group T0 time point showed that there was no significant difference in SVV at each time point in group S(all P>0.05);SVV at T2,T3 and T4 at group C increased significantly(all P<0.05).Compared with the T3 time point,there was no significant difference in the HR of the S group(P>0.05);the HR of the group C at the T4 point was significantly increased(P<0.05);the SVV of the S group at the T4 time point was significantly increased(P<0.05),SVV of the C group at T4,T5,and T6 decreased significantly(all P<0.05).Comparison between groups showed that compared with group C,group S had a significantly lower MAP at time T3(P<0.05),HR at T4,T5,T6 was significantly lower(all P<0.05),CI at T3,T4,T5 significantly increased(all P<0.05),and SVV decreased significantly at T2,T3,T4,T5,T6(all P<0.05).Compared with group C,theΔMAP T4-T3,ΔMAP T0-T4,ΔHR T0-T3,ΔHR T4-T3,ΔHR T0-T4,ΔSVV T0-T3,ΔSVV T4-T3,ΔSVV T0-T4 in group S were statistically significantly different(all P<0.05).Conclusion SPI can be used as a target to adjust the dose of analgesics during the induction of general anesthesia in patients undergoing cardiac valve replacement,so as to lead to more stable hemodynamics and less fluctuation of the blood pressure and heart rate during the induction process,and improve the safety of anesthesia induction in patients.