全麻诱导期脉搏氧指容积波波幅变异度预测容量反应性的观察

Prediction of volumetric responsiveness by pulse oximetry photoplethysmographic waveform amplitudeduring the induction of general anesthesia

目的应用脉搏氧指容积波波幅变异度(ΔPOP)评估全麻诱导期患者的容量反应性。方法选择ASA分级Ⅰ~Ⅱ、年龄<60岁、择期在全麻下行手术治疗的患者100例,患者入室后连接无创心输出量监测仪(NICOM)和PHILPS监护仪,开放外周静脉后静脉注射咪达唑仑镇静。麻醉诱导后行气管插管、机械通气,观察咪达唑仑镇静后(T_(1))、气管插管前(T_(2))、气管插管时(T_(3))、气管插管后1 min(T_(4))、插管后3 min(T_(5))、插管后5 min(T_(6))的HR、SBP、灌注指数(PI)、总外周血管阻力(TPR)、每搏量变异度(SVV)、ΔPOP变化。结果 T_(4)时刻ΔPOP与SVV的Spearman相关系数为0.19,差异无统计学意义(P>0.05);在T_(5)、T_(6)时刻ΔPOP与SVV的相关系数分别为0.57、0.63,差异均有统计学意义(P<0.05)。结论ΔPOP与SVV具有较好的相关性,ΔPOP可用于评估全麻患者的容量反应性,但易受监测部位血管收缩状态的影响。

Objective To evaluate the volumetric responsiveness by the pulse oximetry photoplethysmographic waveform amplitude(ΔPOP)during the induction of general anesthesia.Methods 100 patients graded for ASA I-II,who were to undergo endotracheal intubation under general anesthesia for elective surgery.After entering the room,the patients were connected with the Noninvasive Cardiac Output Monitoring(NICOM)and PHILPS Monitor,and were sedated by intravenous injection of midazolam after placing the peripheral vein.Tracheal intubation and mechanical ventilation were performed after anesthesia induction.HR,SBP,perfusion index(PI),total peripheral vascular resistance(TPR),stroke volume variability(SVV)andΔPOP were observed after midazolam sedation(T_( 1)),before tracheal intubation(T_( 2)),during tracheal intubation(T_( 3)),1 min after tracheal intubation(T 4),3 min after tracheal intubation(T_( 5))and 5 min after tracheal intubation(T_(6)).Then the correlation between SVV andΔPOP was analyzed.Results The Spearman’s correlation coefficient between SVV andΔPOP was 0.19 at T 4,it was not statistically significant(P>0.05).The correlation coefficient between the SVV andΔPOP were observed at T 5 and T 6,it were respectively statistical significance(P<0.05).Conclusion There is a good correlations between SVV measured by noninvasive cardiac output monitoring(Bioreactance)andΔPOP.ΔPOP is likely to predict fluid responsiveness,but it is influenced by the vasoconstriction of the monitored site.