脉搏血氧波形实时监测反映有效循环血量变化的研究  

Role of real-time pulse oximetry plethysmographic waveform in reflecting the change of effective circulating blood volume

作　　者：郑亮亮[1] 徐军[1] 朱华栋[1] 李晨[1] 张秋彬 刘业成[1] 于学忠[1] 韩飞 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院急诊科,北京100730 [2]迈瑞生命信息与支持临床研究中心,广东深圳518000

出　　处：《中国急救医学》2014年第6期494-496,共3页Chinese Journal of Critical Care Medicine

基　　金：国家临床重点专科建设项目;首都医学发展基金项目（2011-4001-04）

摘　　要：目的 初步探讨脉搏血氧波形相关参数包括波幅（Amp）、曲线下面积（AUC）反映机体前负荷变化的意义.方法 观察22名清醒的健康志愿者在被动抬腿试验（PLR）过程中脉搏血氧相关参数及心率（HR）、血压的变化情况.结果 受试者基线状态下HR与PLR时比较差异无统计学意义[（72.1±11.3）次/min vs （70.1±11.3）次/min,P=0.10）;而平均动脉压（MAP）[（86.0±8.4）mm Hg vs （77.3±8.9） mm Hg,P＜0.01）、脉搏血氧波形Amp（1043±585 vs2140±1101,P＜0.01）、AUC（4931±544 vs 5612±540,P＜0.01）在基线与PLR3 min时比较差异有统计学意义.结论 脉搏血氧波形Amp与AUC在PLR中表现出明显变化,表明脉搏血氧波形波幅与AUC可以反映有效循环血容量变化,脉搏血氧波形（PPG）可能成为便捷、无创、实时的监测循环前负荷工具.Objective To investigate the effect of amplitude and area under the curve （AUC） of pulse oximetry plethysmographic waveform （PPG） in reflecting preload changes.Methods A total of 22 awake,healthy volunteers were enrolled in the study.The changes in parameters of pulse oximetry plethymographic such as amplitude and AUC,heart rate and blood pressure before and after passive leg raising （PLR） test were observed.Results There was no significant difference in heart rate between baseline and PLR （72.1 ± 11.3 vs 70.1 ± 11.3,P =0.10）.Mean arterial pressure between baseline and 3 minutes after PLR showed significant difference [（86.0 ± 8.4） mm Hg vs （77.3 ± 8.9） mm Hg,P ＜0.01].Amplitude of PPG of 3 minutes after PLR was significantly higher that of baseline （2140 ± 1101 vs 1043 ± 585,P ＜ 0.01）.AUC of PPG was significantly increased at 3 minutes after PLR as compared with that at baseline （5612 ±540 vs 4931 ±544,P ＜0.01）.Conclusion Amplitude and AUC of PPG waveform in PLR trials showed significant changes,which indicated that amplitude and AUC of PPG waveform can reflect the change of the effective circulating blood volume.PPG waveform could be a convenient,noninvasive and real-time monitoring tool of preload.

关 键 词：脉搏血氧波幅(Amp) 脉搏血氧曲线下面积(AUC) 被动抬腿试验(PLR) 

分 类 号：R720.597[医药卫生—急诊医学]