灌注指数变异度监测伤害性刺激反应的评价  

Evaluation of pleth variability index in the monitoring of noxious stimulus

作　　者：张建海[1] 徐子锋[1] 郑吉建[1] 王莹恬[1] 

机构地区：[1]上海交通大学附属第一人民医院麻醉科,200080

出　　处：《国际麻醉学与复苏杂志》2013年第11期974-976,985,共4页International Journal of Anesthesiology and Resuscitation

基　　金：上海市科学技术委员会科技支撑资助项臼（124119a3400）

摘　　要：目的评价灌注指数变异度（pleth variability index，PVI）对伤害性刺激反应的监测作用。方法择期行胃部手术患者，按随机数字表法随机分为两组：单纯气管插管全身麻醉（GA）组和全身麻醉联合硬膜外阻滞（GE）组，每组30例。硭录手术切皮前后的心率（heart rate，HR）、平均桡动脉压mean radial artery blood pressure，MBP）、灌注指数（perfusion index，P1）和PVI。结果两组手术切皮前后，HR和MBP变化差异无统计学意义（P〉0．05）。GA组PI在手术切皮后1min和5rain均显著下降，切皮前为（2．7±0．6）％，手术切皮后1min和5min分别降低为（0．77±0．28）％和（0．7±0．4）％。PVI均大幅增加（P〈0．05），切皮前为（10．8±2．6）％，手术切皮后1min和5min分别（23．7±3．6）％和（26．6±4．1）％；GE组切皮前后PI和PVI差异无统计学意义（P〉0．05）。两组组间比较，手术切皮前各项指标差异无统计学意义。手术切皮后1min和5min，HR和MBP差异无统计学意义（P〉0．05），PI和PVI差异有统计学意义（P〈0．05）。比较切皮前后PI和PVI呈显著负相关。结论PVI是一种无创监测手术伤害性刺激反廊的有效指标。Objective To investigate whether the pleth variability index （PVI）, a noninvasive and continuous tool, was to predict the nociceptive stimulus. Methods Patients with ASA status I -lI undergoing gastric operation were randomly divided into two groups： tracheal intubation general anesthesia （group GA） and combined general-epidural anesthesia （group GE） in 30 cases. Heart rate （HR）, mean radial artery blood pressure （MBP）, perfusion index （PI）, PVI were recorded before and after the skin ineision. Results The skin incision did not affect the HR and MBP in two groups. The PI in group GA decreased significantly from（2.7±0.6）% to （0.77±0.28）% and （0.7±0.4）% at 1 min and 5 rain after the skin incision. The PVI increased significantly form （10.8±2.6）% to （23.7±3.6）% and （26.6±4.1）% at 1 min and 5 rain after the skin incision. Both the PVI and the PI had no significant change in group GE after the skin incision. There were significant differences of PI and PVI between two groups after the skin incision. A significant negative correlation was observed between the changes in PI and PVI before and after the skin incision. Conclusions The PVI is a noninvasive and effective tool to monitor the patient＇s noxious stimulation.

关 键 词：灌注指数 灌注指数变异度 伤害性刺激 

分 类 号：R614[医药卫生—麻醉学]