摘要
目的 评价末梢灌注指数（TPI）监测全麻患者应激反应的可行性。方法 择期颅脑外科手术患者20例，ASAⅡ级，连续监测手指刑、指端皮温（T）、脑电双频谱指数（BIS）、收缩压（SP）、舒张压（DP）及心率（HR）。分别于麻醉诱导前（t0）、静脉注射咪达唑仑后1min（t1）、3min（t2）、气管插管前即刻（t3）、插管后即刻（t4）、插管后1min（t5）、上头架前即刻（t6）、上头架后即刻（t7）、上头架后1min（t8）、切皮前即刻（t9）、切皮后即刻（t10）、切皮后1min（t11），记录各指标。结果 与t0比较，t1-11时BIS降低，t1-7、t9-11。TPI增高，t2-7、T9-11时SP降低，t2-4,t6-11时DP降低，t3-6时HR减慢，t7时HR增快，t6-11T升高（P〈0．05）；与t3比较，t4,5时BIS和HR差异无统计学意义（P〉0．05），喇降低、SP和DP增高（P〈0．05）；与t6比较，t7,8时BIS差异无统计学意义（P〉0．05），TPI降低、SP和DP增高、HR增快（P〈0．05）；与t9比较，t10，11时BIS和HR差异无统计学意义（P〉0．05），TPI降低、SP和DP增高（P〈0．05）。TPI与SP、DP和HR呈负相关，r分别为-0．618、-0．481、-0.335（P〈0．01）。结论 TPI可无创、实时、连续地监测全麻患者应激反应状态下交感张力的变化。
Objective To evaluate the feasibility of finger tip perfusion index （TPI） for stress response monitoring during general anesthesia. Methods Twenty ASA Ⅰ or Ⅱ neurosurgical patients of both sexes （ 11 male, 9 female） aged 19-45 yrs, weighing 46-78 kg undergoing elective intracranial surgery under general anesthesia were enrolled in this study. The patients were unpremedicated and received lactated Ringer＇s solution 10-12 ml/kg before induction of anesthesia. Anesthesia was induced with midazolam 0.04 mg/kg , fentanyl 3 μg/ kg, and propofol 1.5 mg/kg. Tracheal intubation was facilitated with vecuronium 0.1 mg/kg. The patients were mechanically ventilated （VT 8-10 ml/kg, RR 10-12 bpm, I ： E 1 ： 2）. PET CO2 was maintained at 35-45 mm Hg. Anesthesia was maintained with TCI of propofol （target plasma concentration was set at 3.2 μg/ml）. Fentanyl 50- 100μg was given Ⅳ before skin incision. The TPI, the skin temperature of finger tip, BIS, systolic and diastolic BP and HR were monitored with HXD-type Ⅰ multi-function monitor before induction of anesthesia （baseline, To ）, 1 and 3 rain after midazolam （T1 , T2 ）, immediately before, during and 1 min after intubation （T3 , T4, T5 ）, immediately before the head was fixed on head holder （T6 ）, while the head was being fixed （T7）, 1 min after head was fixed （T8）, immediately before, during and 1 min after skin incision （T9, T10, T11 ）, and recorded. Results BIS value was significantly decreased at T1-11 as compared with the baseline at To . Tracheal intubation, head fixation and skin incision decreased TPI and increased SP and DP. TPI was negatively correlated with SP, DP and HR （r = - 0.618, - 0.481 and - 0.335, respectively P 〈 0.01 ）. Conclusion TPI can be used to monitor the sympathetic reactively noninvasively, instanilv and continuously during general anesthesia.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2007年第2期117-119,共3页
Chinese Journal of Anesthesiology
关键词
应激
麻醉
全身
体积描记术
Stress
Anesthesia, general
Plethysmography
