灌注指数对伤害性刺激反应的临床监测作用  

Perfusion index for clinical monitoring of noxious stimuli

作　　者：朱晓霞[1] 张富军[1] 于布为[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院麻醉科,200025

出　　处：《上海医学》2010年第2期151-155,共5页Shanghai Medical Journal

基　　金：上海市自然科学基金(03ZR14046)资助项目

摘　　要：目的评价灌注指数对全凭静脉麻醉患者伤害性刺激反应的监测作用。方法择期行妇科开腹手术的患者36例,依芬太尼剂量随机分成3组:Ⅰ组,予芬太尼1μg/kg;Ⅱ组,予芬太尼3μg/kg;Ⅲ组,予芬太尼5μg/kg。用丙泊酚靶控、不同剂量的芬太尼和0.1 mg/kg维库溴铵行麻醉诱导。丙泊酚的效应室浓度达3μg/mL时行气管插管,达3.9μg/mL时行手术切皮。在诱导前、诱导期间(效应室浓度1、2、3μg/mL)、气管插管后(10、306、0 s)和切皮后(10、30、60、120 s)等时间点,记录心率(HR)、平均动脉压(MAP)、脑电双频指数(BIS)和灌注指数(PI)。结果当伤害性刺激出现时,PI迅速明显降低,而HR只在插管时显著增快,MAP只在切皮时显著升高。所有患者在气管插管开始后(43±7)s及在切皮后(17±5)s时,均出现PI谷值。在气管插管期间,89%(34/36)的患者PI降幅>基础值的20%,其中31例PI降幅>基础值的30%。PI降幅>基础值的20%的构成比显著高于HR增幅>基础值的20%的构成比(54%,20/36,P=0.002)。在切皮过程中,所有患者(100%)的PI降幅>基础值的20%,其中35例PI降幅>基础值的30%。PI降幅>基础值的20%的构成比显著高于MAP增幅>基础值的20%的构成比(36%,13/36,P<0.01)。结论PI能迅速、有效地反映全凭静脉麻醉期间气管插管和手术切皮等伤害性刺激反应。Objective To assess the role of perfusion index in monitoring noxious stimuli during total intravenous general anesthesia.Methods Thirty-six patients undergoing gynecological celiotomy were randomly assigned to three groups according to different dosages of fentanyl used（n=12）： Group Ⅰ,fentanyl 1 μg/kg;Group Ⅱ,fentanyl 3 μg/kg,and Group Ⅲ,fentanyl 5 μg/kg.Anesthesia was induced by target-controlled infusion（TCI） of propofol,different doses of fentanyl and 0.1 mg/kg vecuronium.Tracheal intubation was performed when effect compartment concentration（ECC） of propofol reached 3 μg/mL（the beginning of tracheal intubation） and skin incision was done when reached 3.9 μg/mL（the beginning of incision）.The heart rate（HR）,mean arterial pressure（MAP）,bispectual index and perfusion index were record at the following time points： baseline,concentration of propofol（1,2 and 3 μg/mL）,process of intubation（10,30,60 s） and process of skin incision（10,30,60,and 120 s）.Results When there were noxious stimuli,the perfusion index decreased remarkably and immediately;HR increased significantly only after intubation and MAP increased only after incision.The perfusion indices were obviously changed in almost every patients,with the lowest values appearing at（43±7） s after intubation and（17±5） s after incision.During the intubation,perfusion index decreased by more than 20% of the baseline value in 89%（34/36） patients,and decreased by more than 30% in 31 patients.The proportion of patients with decreased HR was significantly higher than that with increased HR（n=20,P=0.002）.During the incision,perfusion index decreased by more than 20%,with those in 35 patients decreased by more than 30%.The proportion of patients with decreased perfusion index significantly higher than those with increased MAP（n=13,P0.01）.Conclusion Perfusion index can reflect the noxious stimuli of the intubation and the incision effectively and immediately.（Shanghai Med J,2010,33： 151-155）

关 键 词：灌注指数 脑电双频指数 靶控输注 伤害性刺激 

分 类 号：R614[医药卫生—麻醉学]