脉搏灌注变异指数监测血容量变化的有效性  

The study of pleth variability index in monitoring fluid responsiveness under combined general-epidural anesthesia

作　　者：徐子锋[1] 张建海[1] 郑吉建[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：《临床麻醉学杂志》2013年第12期1187-1189,共3页Journal of Clinical Anesthesiology

基　　金：上海科学技术委员会科技支撑资助项目(124119a3400)

摘　　要：目的探讨脉搏灌注变异指数（PVI）监测全麻复合硬膜外阻滞血容量变化的有效性。方法拟在全麻复合硬膜外阻滞下行上腹部手术患者23例，年龄20-60岁。记录硬膜外给药前及给药后5、10、15、20min时SBP、DBP、HR、每搏量（SV）、每搏量变异度（SVV）、脉搏灌注指数（PI）和PVI的变化。结果与给药前比较，硬膜外给药后5～20min，SBP、DBP、SV明显降低、SVV、PVI明显升高（P〈0．01）。PVI和SVV呈显著正相关（r=0．689，P〈0．01）。结论PVI能有效判断全麻复合硬膜外阻滞后血容量的变化。Objective This study was aimed to observe clinical application of pleth variability index（PVI）in monitoring fluid responsiveness under combined general-epidural anesthesia, to analyze the correlation between PVI and SVV in fluid monitoring, and to evaluate the significance of PVI and SVV in clinical anesthesia monitoring. Methods Twenty-three ASA I or II , aged 20-60 years patients scheduled for elective abdominal surgery, patients were connected to monitor and underwent intravertebral anesthesia at the block level of T8-T9, a test dose of 4 ml lidocaine （1%） was injected. After induction of general anesthesia, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR）, stroke volume （SV）, stroke volume variation （SW）, perfusion index （PI） and PVI were continuously monitored. The data mentioned above were recorded before intraspinal administration, and at minute 5, 10, 15 and 20 min after intraspinal administration. Results There were significant differences between SBP, DBP, SV, SVV and PVI before and after intravertebral anesthesia （P〈0.01）. HR did not differ significantly before and after intravertebral anesthesia. PVI were positively associated with SVV （r=0. 689, P〈0. 01）. Conclusion PVI and SVV proved to be well related in fluid monitoring, can monitor the fluid changes of patients effectively and noninvasively during the clinical anesthesia. Pulse oximetry plethysmographic waveform derived indexes （PI and PVI） can respond to the changes in the tension of sympathetic nerves and dynamic alteration of fluid in patients effectively.

关 键 词：脉搏灌注变异指数 每搏量变异度 血流动力学 

分 类 号：R614[医药卫生—麻醉学]