脉搏灌注指数在肝移植术中的监测意义

The monitoring significance of perfusion index in liver transplantation

目的探讨脉搏灌注指数(Perfusion index,PI)在肝移植术中的监测意义。方法2019年11月至2020年8月行肝移植手术患者22例。入室后使用脉博血氧饱和度监测仪与患者食指连接,测量部位保持静态、避光。快速诱导后超声引导下进行有创穿刺。麻醉维持采用静吸复合方式,并根据术中情况调整麻醉深度,必要时使用血管活性药物维持血流动力学稳定。术中持续监测PI、ECG、SpO_(2)、HR、BP、T、CVP、ICVP、CO、CI、SV、SVV、SVI,分别于肝移植各重要时间点行动脉血气分析记录患者电解质、BE、pH、Glu、Lac等内环境情况,记录患者围术期一般情况。对患者进行术后随访,记录拔管时间、术后并发症及术后住院时间。结果术中各重要时间节点生命体征相对于术前水平的变化率中PI的变化率高于MAP、HR、T(P<0.05);PI与SV、SVI呈中度相关,与CVP、ICVP、CO、CI、SVV成低度相关;术中PI与HCO-3呈正相关(P<0.05),与Lac呈负相关(P<0.05);术后延迟拔管、术后发生严重并发症、术后住院时间延长的患者PI值较对照组低。结论①肝移植术中PI的变化率较为敏感,其变化与SV、SVI呈中度相关;②肝移植术中PI的低迷可能提示患者综合预后较差,PI值的变化可作为肝移植术后患者近期康复和预后的参考指标之一。

Objective To explore the monitoring significance of perfusion index in liver transplantation.Methods From November,2019 to August,2020,twenty-two patients underwent liver transplantation under general anesthesia.The pulse oxygen saturation monitor was used to connect the patient's index finger,and the measuring site was kept static and protected from light.After the rapid induction,invasive puncture were performed under the guidance of ultrasound.Intravenous-inhalation combined anesthesia was taken during operation.The depth of anesthesia should be adjusted according to the situation during the operation,and vasoactive drugs were used,if necessary,to maintain hemodynamic stability.ECG,SpO_(2),HR,SBP,DBP,MAP,PI,T,CVP,ICVP,CO,CI,SV,SVV and SVI were continuously monitored during operation.At each important time point of liver transplantation,the blood gas analysis of arterial blood gas was used to record the internal environment of the patients,such as electrolyte,BE,pH,Glu,Lac and so on.The general condition of the patients during the perioperative period was recorded.The patients were followed up,and the time of extubation,postoperative complications and postoperative hospital stay were detected.Results The change rate of PI in vital signs of each important time node relative to the preoperative level during operation was higher than that of MAP,HR and T.PI was moderately correlated with SV and SVI,and low correlated with CVP,ICVP,CO,CI and SVV.PI was positively correlated with HCO-3 and negatively correlated with Lac during liver transplantation.The PI values of patients with delayed extubation,serious postoperative complications and prolonged postoperative hospital stay were lower than those in the control group,but due to sample size limit,it was necessary to expand the sample study.Conclusion(1)The change rate of PI is relatively sensitive in liver transplantation,and this change is moderately correlated with SV and SVI.(2)The downbeat variation of PI indicates the poor general prognosis of patients and the change of perfusion index could be used as one of indexes predicting the nearby recovery and prognosis of patients after liver transplantation.