不同手术刺激对瑞芬太尼复合全麻下脉搏波的影响  

Effects of different surgical stimulation on photoplethysmography in patients anesthetized by remifentanil

作　　者：余伊[1] 徐磊[1] 鲍红光[1] 史宏伟[1] 陈宝林[1] 胡夏娟[1] 朱中良[1] 

机构地区：[1]南京医科大学附属南京医院麻醉科,江苏南京210006

出　　处：《徐州医学院学报》2015年第9期598-601,共4页Acta Academiae Medicinae Xuzhou

基　　金：南京医科大学科技发展重点基金项目（07NMUZ041）;南京市医学科技发展资金

摘　　要：目的通过观测不同手术刺激下指光电容积脉搏波（finger photoelectric plethysmography，FPPG）变化的情况，探讨运用FPPG进行围术期伤害性感受监测的可行性。方法选择择期行乳腺癌根治术患者60例，ASAⅠ-Ⅱ级，女性，年龄20～60岁；依据不同手术刺激将其分为3组（n=20）：S1组（超声刀组）、S2组（电刀组），S3组（钳夹组）。麻醉诱导后完成气管内插管，并行机械通气，麻醉中常规监测心电图（ECG）、血氧饱和度（SpO2）、呼气末二氧化碳分压（ETCO2）、收缩压（SBP）、舒张压（DBP）、心率（HR）。于手术开始后5min（T1）、10min（T2）、15min（T3）分别给予超声刀、电刀、钳夹刺激，采集手术切皮前（T0）及各点刺激前后患者FPPG信号，各时点描记光电容积指脉搏波形30s，数据进行离线分析。结果3组T1、T2、T3时刻刺激前后脉搏波幅度均减小（P〈0．05）且幅度随刺激强度而改变。S1组SBP在各点刺激后均升高（P〈0．05），S2组SBP在T1时刻刺激后升高（P〈0．05）。DBP、HR变化均无统计学意义。结论围术期伤害性刺激反应和指光电容积脉搏波波幅（photoe—lectric plethysmography amplitude，PPGA）变化有一对一的关系。随伤害性刺激强度增大，围术期光电容积指脉搏波变化幅度增大，应激性刺激反应程度增强；FPPG可能成为一种潜在的新型围术期伤害性刺激反应的实时、不间断性监测方法。Objective To evaluate the feasibility of nociception monitoring of patients in perioperative period through observing the changes in finger photoplethysmograpby （FPPG） after different surgical stimulations. Methods A total of 60 ASA Ⅰ - Ⅱ female patients aged from 20 to 60 years old were included into the current study, who underwent breast cancer operation. They were divided into three groups according to different surgical stimulations （n = 20） ： a harmonic scalpel group （S1） , an electrotome group （S2） and a forceps clip group （S3）. The CSI was maintained between 40 to 60. Then, ECG, SPO2 , ETCO2, SBP, DBP and HR were monitored during anesthesia. The changes of finger photoelectric plethysmography （FPPG） were recorded from right index finger of the patients at the following time points： before surgical incision （T0） , 5 min after surgical incision （T1） with stimulation of harmonic scalpel, 10 min after surgical incision （T2） with stimulation of electrotome, and 15 min before surgical incision （T3） with stimulation of forceps clip. The data obtained were adopted for offline analysis. Results After stimulation, all groups presented reduced FPPG amplitudes at T1, T2 and T3 （ P 〈 0.05 ） , while the amplitudes were increased as stimulation enhanced. The S1 group produced higher SBP at each time points, while the S2 group produced higher SBP at T1 （ P 〈 0.05 ）. No statistical difference was seen as to the changes of HR and DBP. Conclusion Noeiception in perioperative period is associated with PPG amplitudes. The stronger nociception is, the larger PPG amplitudes are. PPG is a potential method to monitor noci- ception in perioperative period.

关 键 词：指光电容积脉搏波 伤害性刺激反应 全身麻醉 麻醉深度 

分 类 号：R614[医药卫生—麻醉学]