动脉压与脉氧饱和度波形相关性的改变  

Correlation of arterial pressure and pluse oximetry plethysmographic waveform during changes in blood volume

作　　者：许海芳[1] 周曙[1] 于布为[1] 

机构地区：[1]上海第二医科大学附属瑞金医院麻醉科,200025

出　　处：《中华麻醉学杂志》2000年第6期350-353,共4页Chinese Journal of Anesthesiology

摘　　要：目的　通过急性非同步等容性血液稀释 ,观察急性血容量变化引起的动脉波与脉氧波的改变的相关性 ,以探讨用脉搏血氧饱和度波形估测血容量减少的可行性。方法　 10例择期手术成年患者全麻气管插管后 ,输入 75 0 ml液体 ,记录动脉波的收缩压变化 (SPV )、d Down(delta down)、d Up(delta up)和脉氧波的 SPVplet、d Downplet、d Upplet以及心输出量等血液动力学参数 ;再经桡动脉快速放血 30 0 ml及输入等量琥珀酰明胶后分别记录各参数。结果　急性失血 30 0 ml后 ,d Down和d Downplet分别由 (4 .5 9± 2 .94) mm Hg和 (10 .2 4± 5 ^32 ) %增至 (7.0 0± 3.36 ) mm Hg和 (16 .11±7.44 ) % ,其变化呈正相关 (r=0 .80 4,P=0 .0 0 5 ) ,d Down、SPVplet和 d Downplet与置换前有显著性差异(P<0 .0 5 )。用等量琥珀酰明胶置换后 ,中心静脉压、肺动脉嵌压、心输出量、SPV、d Down、SPVplet、d Downplet与置换前有显著性差异 (P<0 .0 5 )。结论　在正压通气条件下 ,脉氧波形监测能有效地估测急性血容量减少。Objective To assess the feasibility of using plethysmographic waveform variation for estimating the blood volume.Methods After general anesthesia,tracheal intubation and 750ml liquid infusion,the systolic pressure variation(SPV),dDown(delta down),dUp(delta up),SPV plet,dDown plet,dUp plet,cardiac output and other hemodynamic parameters were recorded as control.Then,300ml of blood were drained quickly from radial artery into reservoir bag,and replaced with equal volume Gelofusine.The parameters were recorded again after blood drainage and volume replacement respectively.Results The changes in plethysmographic waveform correlated well with changes in arterial dDown(r==0804 ,P=0005)after acute loss of 300ml blood and dDown and dDown pletincreased from(459±294)mm Hg and (1024±532)% to (700±336)mm Hg and (1611±744)% respectively.Moreover,dDown,SPV plet and dDown pletvaried significantly(P<005)After replacement with 300ml Gelofusine,CVP,PAWP,CO,SPV,dDown,SPV plet and dDown plet all varied significantly compared with those in hypovolemia (P<005).Conclusions Pulse oximetry plethysmographic waveform is useful for estimation of acute blood loss during positive pressure ventilation.

关 键 词：血氧测定法 动脉压 血液稀释 全身麻醉 

分 类 号：R614[医药卫生—麻醉学]