脉搏灌注变异指数预测剖宫产产妇硬膜外阻滞后发生低血压的可行性  

Significance of pleth variability index in predicting hypotension after epidural anesthesia for cesarean delivery

作　　者：彭永保[1] 周群[1] 郑剑锋[1] 刘淮[1] 

机构地区：[1]江西省妇幼保健院麻醉科,330006

出　　处：《实用医学杂志》2016年第6期964-966,共3页The Journal of Practical Medicine

基　　金：江西省卫生计生委科技计划(编号:20155547)

摘　　要：目的：探讨脉搏灌注变异指数（PVI）预测剖宫产产妇硬膜外阻滞后发生低血压的可行性。方法：选取足月择期行硬膜外麻醉下剖宫产产妇67例,年龄19~34岁,ASA分级Ⅰ~Ⅱ级。产妇入手术室平稳呼吸5 min后监测和记录SBP、BDP、MAP、HR、PI和PVI值,硬膜外腔给药后每3 min测量1次SBP、BDP、MAP、HR,计算每个指标与其麻醉前基础值的最大变化率,并按SBP或MAP的下降幅度是否超过基础值的30%,分为低血压组和无低血压组。结果：两组产妇的年龄、身高、体重、体质指数、孕周及SDP、DBP、MAP、HR的基础值的比较差异均无统计学意义（P〉0.05）,低血压组产妇的麻醉前PVI值高于无低血压组,差异有统计学意义（P〈0.05）。以不同PVI值为界值绘制ROC曲线,曲线下面积为0.888,如以PVI值17.35作为发生低血压的界值,PVI预测硬膜外麻醉后剖宫产术发生低血压的敏感度为0.727,特异度为0.895。结论：麻醉前PVI值可以用来预测硬膜外阻滞后剖宫产术中低血压的发生。Objective Onto investigate the significance of the pleth variability index（PVI） in predicting hypotension after epidural anesthesia for cesarean delivery. Methods Sixity seven pregnant women, with ASAⅠ~ Ⅱ, aged 19 ~ 34 years, were enrolled for elective cesarean delivery. SBP, BDP, MAP, HR, PI and PVI were measured at 5 min after the parturients arrived in the operation room. SBP, BDP, MAP and HR were measured every 3 min after epidural anesthesia. According to the change rate of SDP or MAP was higher than30% or not, the parturients were divided into two groups（the hypotension group and the non-hypotension group）.Results No significant differences were found in parturients′age, body height, weight, BMI, gestational weeks,SDP, DBP, MAP and HR before anesthesia between two groups. The PVI in the hypotension group was significantly higher than that in the non-hypotension group（P〈0.05）. A receiver operator characteristic curve analysis showed the area under curve was 0.888 when PVI was used for boundary value. When PVI over 17.35 was used as the occurrence of hypotension, the sensitivity of PVI was 0.727, and specificity was 0.895. Conclusion PVI can be used to predict the occurrence of hypotension after epidural anesthesia for cesarean delivery.

关 键 词：脉搏灌注变异指数 剖宫产术 硬膜外腔阻滞 血流动力学 

分 类 号：R614[医药卫生—麻醉学]