天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (10): 1175-1178.doi: 10.11958/j.issn.0253-9896.2015.10.024

• 应用研究 • 上一篇    下一篇

指端光电容积脉搏波监测全麻诱导期伤害性应激反应的准确性

  

  1. 1石河子大学医学院 （邮编 83200）； 2石河子大学医学院第一附属医院麻醉科
  • 收稿日期:2014-12-29 修回日期:2015-05-12 出版日期:2015-10-15 发布日期:2015-10-22

Accuracy of photoplethysmograph pulse wave in monitoring stress response from harmfulness#br# during anesthetic induction

  1. 1 Medical College of Shihezi University, Shihezi 832000, China; 2 Department of Anesthesiology, First Affiliated Hospital of
    Medical College, Shihezi University
  • Received:2014-12-29 Revised:2015-05-12 Published:2015-10-15 Online:2015-10-22

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摘要： 摘要： 目的 评价指端光电容积脉搏（PPGPW）波的变化用于监测全麻诱导期机体伤害性应激反应的准确性。
方法 根据麻醉诱导期 75 例患者对芬太尼的剂量按 4、 5 及 6 μg/kg 分为 F4、 F5、 F6组， 每组 25 例。分别于入室时
（T1）、 诱导后 2 min （T2）、 气管插管即刻 （气管插入声门 10 s， T3）、 插管后 1 min （T4） 及插管后 5 min （T5） 连续监测并记录
患者心率 （HR）、 收缩压 （SBP）、 舒张压 （DBP）、 血氧饱和度 （SpO2）、 手指温度、 末梢灌注指数 （PI）、 血浆肾上腺素 （E）、
去甲肾上腺素（NE）及 PPGPW 波并测量其振幅（PPGA）。结果 与 T1相比， T2和 T5 3 组 PPGA 及 PI 升高， E 和 NE
减小（P < 0.05）， T3时刻 F4组和 F5组 PPGA 及 PI 降低， NE 升高（P < 0.01）， F4组 E 升高（P < 0.05）， F5组 E 无明显变
化 （P > 0.05）； F6组 T2、 T3、 T4和 T5时刻 PPGA 和 PI 均升高， E 和 NE 均减小 （P < 0.05）。PPGA 与 E、 NE 呈负相关 （r 分
别为-0.406 和-0.484， P < 0.05）， PI 与 E、 NE 呈负相关 （r 分别为-0.378 和-0.440， P < 0.05）。结论 PPGA 和 PI 与伤
害性应激反应程度呈负相关， 可以准确监测全麻诱导期的伤害性应激。

关键词: 麻醉, 全身, 芬太尼, 插管法, 气管内, 光电容积脉搏波, 伤害性应激反应, 灌注指数, 肾上腺素, 去甲肾上腺素

Abstract:

Abstract: Objective To envaluate the accuracy of Photoplethysmograph pulse wave in monitoring stress reaction to
harmful stimulation. Methods Patients (n=75) were randomly assigned to three groups according to the dosages of fentanyl
that were administrated ( 4, 5 and 6 g/kg were given to F4, F5, F6 group respectively (n=25) in each group. Heart rate (HR),
Systemic blood pressure (SBP), Diastolic blood pressure (DBP), SpO2, the skin temperature of finger, perfusion index (PI), epi⁃
nephrine(E) and Norepinephrine (NE) were recorded at following time points: just in operation room (T1), 2 min after induc⁃
tion (T2), at intubation (T3),1 min (T4) and 5 min (T5) after intubation. And the PPGPW was printed and measured at the same
time points. Results PPGA and PI were significantly increased while E and NE were significantly decreased in T2 and T5,
compared with those baseline at T1 (P < 0.05). At T3, PPGA and PI were significantly decreased while NE markedly in⁃
creased in group F4 and F5 compared to T1. At T3, E in group F4 were remarkably increased h while E in group F5 were of no
obvious changed, compared with those at T1(P < 0.05). PPGA and PI increased while E and NE decreased in group F6 at T2,
T3 ,T4 and T5 compared with those at T1 (P < 0.05). In summary, PI was negatively correlated with plasma E and NE while PP⁃
GA was negatively correlated with plasma E and NE .Conclusion PPGA and PI are negatively associated with intensity of
stress response. And they can reflect the stress reaction during the induction period of intravenous anesthesia accurately.

Key words: anesthesia, general, fentanyl, intubation, intratracheal, photoplethysmography, nociceptive stress, perfu?
sion index, epinephrine, norepinephrine