手术体积描记指数对老年食管癌根治术患者双腔管插管以及切皮心血管反应的预测价值

Predictive value of surgical pleth index for cardiovascular responses to double-lumenendotracheal intubation and skin incision in elderlypatients undergoing esophageal cancer radical operation

目的探讨及评价在老年食管癌患者中手术体积描记指数(SPI)对双腔管气管插管时机以及切皮心血管反应的预测价值。方法选择2021年1月—8月于复旦大学附属肿瘤医院择期行两切口食管癌根治术的老年患者58例。分别记录患者T0(麻醉前)、T1(诱导后1 min)、T2(诱导后2 min)、T3(气管插管前即刻)、T4(插管后2 min内的最高值)、T5(切皮前2 min)、T6(切皮前1 min)、T7(切皮前即刻)、T8(切皮后2 min内的最高值)的心率(HR)、平均动脉压(MAP)及SPI值。同时记录气管插管前即刻以及切皮前即刻时的异丙酚以及瑞芬太尼的效应室浓度。心血管反应与相关临床因素的相关性采用Logistic回归分析;气管插管以及切皮前即刻SPI值对心血管反应的预测效能则用受试者工作特征曲线(ROC曲线)判断。结果不论双腔管插管前即刻SPI值,还是切皮前即刻SPI值,均与二者的心血管反应有相关性(P=0.002、P=0.001);分析ROC曲线的结果显示,双腔管插管心血管反应的SPI预测曲线下面积(AUC)为0.78(P=0.001,95%CI 0.64-0.91),预测最佳界值为12;切皮心血管反应的SPI预测AUC为0.80(P=0.001,95%CI 0.67-0.92),预测最佳界值为26。结论老年食管癌根治术患者SPI值与双腔管插管以及切皮的心血管反应相关,可用于预测该人群双腔管气管插管以及手术切皮时的心血管反应,并指导插管时机。

Objective To investigate and evaluate the value of surgical pleth index(SPI)in predicting the timing of double-lumen endotracheal intubation and the cardiovascular response to skin incision in elderly patients undergoing esophageal cancer radical operation.Methods A total of 58 elderly patients who received two-incision esophageal cancer radical operation in Affiliated Cancer Hospital of Fudan University from January to August 2021 were selected.The heart rate(HR),mean arterial pressure(MAP)and SPI of patients at T0(before anesthesia),T1(1 min after induction),T2(2 min after induction),T3(immediately before tracheal intubation),T4(the highest value within 2 min after intubation),T5(2 min before skin incision),T6(1 min before skin incision),T7(immediately before skin incision),T8(the highest value within 2 min after skin incision)were recorded,respectively.The effectconcentrations of propofol and remifentanil were recorded immediately before endotracheal intubation and immediately before skin incision.Logistic regression analysis was used to determine the correlation between cardiovascular responses and related clinical factors.The predictive efficacy of SPI immediately before endotracheal intubation and skin incision on cardiovascular response was determined by receiver operating characteristic curve(ROC).Results Both SPI value immediately before endotracheal intubation and SPI value before skin incision were correlated with cardiovascular responses(P=0.002,P=0.001).The results of ROC curve analysis showed that the SPI prediction area under the curve(AUC)for cardiovascular response to double-lumen intubation was 0.78(P=0.001,95%CI 0.64-0.91),and the best prediction threshold was 12;the SPI prediction AUC for cardiovascular response to skin incision was 0.80(P=0.001,95%CI 0.67-0.92),and the best predictive threshold was 26.Conclusion The SPI value of elderly patients undergoing radical esophagectomy is related to the cardiovascular response of double-lumenendotracheal intubation and skin incision.It can be used to predict the cardiovascular response of double-lumen endotracheal intubation and skin incision in this population,and guide the timing of endotracheal intubation.