脉搏灌注指数变异在复合麻醉术中诊断价值的研究  

Study on pleth variation index to predict fluid responsiveness during combined general and epidural anesthesia

作　　者：杜芳[1] 薛张纲[1] 仓静[1] 张晓光[1] 

机构地区：[1]复旦大学附属中山医院麻醉科,上海200032

出　　处：《外科理论与实践》2016年第3期244-247,共4页Journal of Surgery Concepts & Practice

摘　　要：目的:比较全身麻醉(G)与全身麻醉复合硬膜外麻醉(GE)术中脉搏灌注指数变异(pleth variation index,PVI)对预测容量治疗反应性的诊断价值。方法:择期肝脏部分切除术病人56例,分为单纯G组和GE组。麻醉诱导后,G组病人硬膜外给予生理盐水,GE组病人给予0.5%布比卡因10 mL,手术开始20 min后,以6%羟乙基淀粉130/0.4氯化钠注射液250 mL快速扩容。记录用药前、硬膜外给药20 min后扩容前及扩容后3 min的PVI及心指数(cardic index,CI)。以△CI≥15%作为容量治疗有效的判断标准,对两组病人的PVI进行受试工作特征曲线分析,比较各时间点PVI的变化。结果:G组PVI监测容量治疗反应性的诊断阈值为12%,灵敏度和特异度分别为87.50%及83.33%,受试工作特征曲线下面积为0.88。GE组PVI的诊断阈值为7%,灵敏度为47.06%,特异度为33.33%,受试工作特征曲线下面积为0.39,不具备预测术中容量治疗反应性的价值。结论:GE中PVI预测容量治疗反应性的价值较单纯G显著降低。Objective To compare pleth variation index（PVI） to predict fluid responsiveness in patients under combined general and epidural anesthesia（GE） with that under general anesthesia（G）. Methods Fifty-six patients undergoing elective hepatectomy were involved and divided into G group and GE group. After induction, 10 mL epidural injection was given with 0.5% bupivaeaine in GE group and NS in G group. Then operation began immediately. Volume challenge with 250 mL 6% hydroxyethyl starch was done 20 minutes later. PVI and eardie index （CI） were measured before epidural injection, before and after volume expansion. Patients were defined as responders when CI increased I〉 15% after volume challenge. Receivers operating characteristie（ROC） curves were generated for PVI to discriminate threshold. Areas under the ROC curves（AUC） were also calculated. Differences of PVI in both groups were analyzed. Results In G group, the cutoff of PVI to predict fluid responsiveness was 12%. The sensitivity and specificity were 87.50% and 83.33% respectively with the AUC of PVI 0.88. In GE group, the cutoff of PVI was 7% with sensitivity of 47.06% and specificity of 33.33%. The AUC of PVI was 0.39, which meant that PVI did not have diagnostic value to predict fluid responsiveness under GE. Conclusions The predictive value of PVI was declined in patients under GE when compared with that under G.

关 键 词：全身麻醉复合硬膜外麻醉 脉搏灌注指数变异 全身麻醉 容量治疗反应性 

分 类 号：R614[医药卫生—麻醉学]