基于心肺交互作用的PI及PVI联合心率对无痛胃肠镜中低血压的预测价值  

Predictive value of PI and PVI combined with heart rate for hypotension during painless gastrointestinal endoscopy based on cardiopulmonary interaction

作　　者：付紫辉 蒋明[1] 张晓坤[1] 史长喜[1] 肖江强[2] 张以洋[2] 吕英 付群 FU Zi-hui;JING Ming;ZHANG Xiao-kun;SHI Chang-xi;XIAO Jiang-qiang;ZHANG Yi-yang;LYU Ying;FU Qun(Department of Anesthesiology,Gulou Hospital,Medical College,Nanjing University,Nanjing 210000,Jiangsu,China;不详)

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,江苏南京210000 [2]南京大学医学院附属鼓楼医院消化内科,江苏南京210000

出　　处：《广东医学》2025年第2期272-277,共6页Guangdong Medical Journal

基　　金：国家自然科学基金资助项目(82100652)。

摘　　要：目的探讨基于心肺交互作用的无创监测指标脉搏血氧灌注指数(PI)及脉搏灌注变异指数(PVI)联合心率对无痛胃肠镜中预测低血压的准确性。方法收集行无痛胃肠镜检查患者108例,根据术中是否发生低血压情况分为低血压组和非低血压组。所有行无痛胃肠镜检查患者均进行SpO_(2)、HR、MAP、PI、PVI和心电图监测。观察计算给药前后HR、PI和PVI的变化情况(△HR、△PI、△PVI),并用ROC评估给药前后及术中HR、PI、PVI、△HR、△PI和△PVI联合HR对低血压的预测作用。结果与未发生低血压患者相比,发生低血压患者的△HR+△PI+△PVI联合预测对预测是否低血压的AUC面积为0.803(0.714~0.893)(P<0.001),特异度为0.781,敏感度为0.816,约登指数为0.597。“△HR+△PI”联合预测对预测是否低血压的AUC面积为0.763(0.663~0.863)(P<0.001),特异度为0.687,敏感度为0.789,约登指数为0.476。“△HR+△PVI”联合预测对预测是否低血压的AUC面积为0.717(0.620~0.814)(P<0.001),特异度为0.937,敏感度为0.526,约登指数为0.463。结论HR联合PI、PVI中的任意一个或同时联合PI、PVI作为一个共同监测指标,可以用于预测无痛胃肠镜中低血压的发生,从而降低低血压的发生率。Objective To explore the accuracy of non-invasive monitoring indices,including pulse oximeter perfusion index(PI)and pulse variation index(PVI),combined with heart rate(HR)in predicting hypotension during painless gastrointestinal endoscopy based on cardiopulmonary interaction.Methods Data from 108 patients undergoing painless gastrointestinal endoscopy were collected and divided into two groups based on the occurrence of hypotension during the procedure:a hypotension group and a non-hypotension group.All patients were monitored for SpO_(2),HR,mean arterial pressure(MAP),PI,PVI,and electrocardiogram parameters.The changes in HR,PI,and PVI before and after drug administration(△HR,△PI,and△PVI)were calculated.Receiver operating characteristic(ROC)curves were used to evaluate the predictive performance of HR,PI,PVI,△HR,△PI,△PVI,and their combinations for hypotension.Results Compared to patients without hypotension,those with hypotension demonstrated better predictive performance when combining△HR,△PI,and△PVI.The area under the ROC curve(AUC)for△HR+△PI+△PVI was 0.803(95%CI:0.714-0.893,P<0.001),with a sensitivity of 0.816,specificity of 0.781,and Youden index of 0.597.The AUC for△HR+△PI was 0.763(95%CI:0.663-0.863,P<0.001),with a sensitivity of 0.789,specificity of 0.687,and Youden index of 0.476.The AUC for△HR+△PVI was 0.717(95%CI:0.620-0.814,P<0.001),with a sensitivity of 0.526,specificity of 0.937,and Youden index of 0.463.Conclusion The combination of HR with either PI,PVI,or both can be utilized as a common monitoring index to predict hypotension during painless gastrointestinal endoscopy,thereby reducing its incidence.

关 键 词：心肺交互作用 无创监测 脉搏灌注指数 脉搏灌注变异指数 无痛胃肠镜 预测低血压 

分 类 号：R614.2[医药卫生—麻醉学] R614.2[医药卫生—外科学]