手术体积描计指数用于纤维支气管镜检查及对脑氧饱和度的影响

Application of surgical plethysmography index for fiberoptic bronchoscopy and its effect on cerebral oxygen saturation

目的评价手术体积描计指数(SPI)用于纤维支气管镜检查术中监测的作用及对脑氧饱和度的影响。方法接受纤维支气管镜检查术患者64例,随机数字表法分为两组,SPI监测组(S组)与对照组(C组),每组各32例,两组患者一般情况无明显差异,所有患者均采取全凭静脉全身麻醉。S组患者采取SPI监测,术中维持30≤SPI≤40,并根据SPI变化调整瑞芬太尼效应室靶浓度。C组患者根据麻醉医师及呼吸内科医师临床经验,当患者发生呛咳体动反应时提高瑞芬太尼效应室靶浓度。观察记录两组患者麻醉诱导前1 min(T0)、麻醉诱导后3 min(T1)、纤维支气管镜进入声门时(T2)、纤维支气管镜到达气管隆突时(T3)、检查结束时(T4)收缩压(SBP)、舒张压(DBP)、心率(HR)、rSO2,并计算心率收缩压乘积(RPP)。记录呛咳体动反应、低氧血症、高血压、低血压发生率及手术时间、苏醒时间。结果T2、T3、T4时,S组患者血压表现更加平稳,HR、RPP明显低于C组,T3、T4时S组患者rSO2高于C组(P<0.05)。S组患者术中呛咳体动反应、低氧血症、高血压、低血压发生率均低于C组,手术时间短于C组(P<0.05)。结论纤维支气管镜检查术中,根据手术体积描计指数监测调整瑞芬太尼效应室靶浓度,可提高rSO2,降低呛咳体动反应、低氧血症、高血压、低血压发生率,血流动力学更加平稳,并缩短手术时间。

Objective To evaluate the role of surgical plethysmography index(SPI)in the monitoring of fiberoptic bronchoscopy and its influence on cerebral oxygen saturation.Methods Sixty-four patients undergoing fiberoptic bronchoscopy examine were randomLy divided into two groups including the SPI monitoring group(group S)and the control group(group C),each had 32 cases.There was no significant difference in general conditions between the two groups All patients underwent general intravenous anesthesia.The patients in group S were monitored by SPI,with 30≤SPI≤40 during operation.and the target concentration of remifentanil effect chamber was adjusted according to the change of SPI.According to the clinical experience of anesthesiologists and respiratory physicians,patients in group C increased the target concentration of remifentanil effect chamber when the patients experienced choking cough and body reaction.Systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),and rSO2 of two groups at 1 min before anesthesia induction(T0),3 min after anesthesia induction(T1),when the fiberoptic bronchoscope entered the glottis(T2),when the fiberoptic bronchoscope reached the trachea protuberance(T3),and when the examination ended(T4)between the two groups were observed and recorded.The heart rate and systolic blood pressure product(RPP)was calculated.The incidences of choking cough and body reaction,hypoxemia,hypertension,and hypotension,as well as the operation time and recovery time,were recorded.Results At T2,T3 and T4,the blood pressure performance of group S was more stable;HR and RPP in group S were significantly lower than that of group C;and rSO2 of group S patients was higher than that of group C at T3 and T4(P<0.05).The incidences of choking cough and body reaction,hypoxemia,hypertension,and hypotension in group S were lower than those in group C,and the operation time in group S was shorter than that in group C(P<0.05).Conclusion During fiberoptic bronchoscopy,adjusting the target concentration of remifentanil according to the operation plethysmography index monitoring can increase rSO2,reduce the incidences of choking cough body reaction,hypoxemia,hypertension,and hypotension.The flow dynamics are more stable and the operation time is shortened.