摘要
目的探讨脉搏氧灌注指数(PI)预测老年全麻诱导期低血压的临床价值。方法选择拟择期实施全麻手术的老年患者120例为研究对象,按照是否发生全麻诱导期低血压将患者分为低血压组(55例)与非低血压组(65例),比较2组一般临床资料(年龄、男性比例、BMI、ASA分级、手术类型)、麻醉诱导药物种类和剂量、麻醉诱导期相关参数(呼气末二氧化碳分压[p ET(CO 2)]、脉搏指氧饱和度[S p(O 2)]、鼻咽温),记录2组诱导前后血流动力学指标、PI及PI增加率,采用Pearson相关性分析PI与血流动力学指标的关系,采用受试者工作特征(ROC)曲线分析PI预测全麻诱导期低血压发生的价值。结果2组男性比例、年龄、BMI、ASA分级、手术类型、麻醉诱导药物种类剂量、麻醉诱导期相关参数比较差异均无统计学意义(P均>0.05)。2组诱导后收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)均低于基础值(P均<0.05),低血压组诱导后SBP、DBP、MAP均明显低于非低血压组(P均<0.05),各指标降低率均明显高于非低血压组(P均<0.05),2组基础HR、诱导后HR及降低率比较差异均无统计学意义(P均>0.05)。2组诱导后PI均明显高于基础PI(P<0.05),低血压组基础PI、诱导后PI、PI增加率均明显高于非低血压组(P均<0.05)。Pearson相关性分析显示,基础PI、诱导后PI、PI增加率分别与SBP、DBP和MAP降低率呈正相关(P均<0.05)。ROC曲线分析显示基础PI、诱导后PI、PI增加率预测全麻诱导期低血压的曲线下面积(AUC)分别为0.782,0.679,0.851,特异度分别为84.3%,67.2%,87.7%,灵敏度分别为79.2%,74.3%,81.4%,最佳界限值分别为3.6%,4.8%,46.4%。其中PI增加率预测的AUC最高,其次是基础PI,诱导后PI最低。结论PI增高可能是老年全麻诱导期低血压发生的有效预测因素,尤其以PI动态变化具有较高的预测价值,有利于临床甄别全麻诱导期低血压发生的高危患者。
Objective It is to investigate the clinical value of pulse oxygen perfusion index(PI)for predicting hypotension during induction of general anesthesia in the elderly.Methods A total of 120 elderly patients who underwent general anesthesia surgery were selected as the research subjects.The patients were divided into hypotension group(55 cases)and non-hypotension group(65 cases)according to whether hypotension occurred during induction of general anesthesia.The general clinical data(age,male proportion,BMI,ASA classification,type of surgery),types and doses of anesthetic-inducing drugs,related parameters in the induction period[end-exhaled carbon dioxide partial pressure(PETCO2),pulse finger oxygen saturation S p(O 2),nasopharyngeal temperature]were compared between the two groups,the hemodynamic indexes,PI and PI increase rate before and after induction in the two groups were recorded,Pearson correlation was used to analyze the relationship between PI and hemodynamic indexes,and receiver operating characteristic(ROC)curve was used to analyze the value of PI for predicting hypotension during induction of general anesthesia.Results There was no significant difference in the proportion of males,age,BMI,ASA classification,type of surgery,kinds and dosage of anesthetic-inducing drugs,and related parameters in anesthesia-inducing period between the two groups(P>0.05).The systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),and heart rate(HR)after induction were lower than the basic values in the two groups(all P<0.05).The SBP,DBP and MAP in the hypotension group were lower and the reduction rates of all indicators were significantly higher than those of the non-hypotension group(P<0.05).There was no significant difference in basic HR,post-induction HR,and their reduction rates between the two groups(P>0.05).After induction,the PI in both groups was significantly higher than the basic PI(P<0.05),and the rates of increase of the basic PI,post-induction PI,and PI in the hypotension group w
作者
李旭泽
赵志芳
马淑贤
杨焱捷
LI Xuze;ZHAO Zhifang;MA Shuxian;YANG Yanjie(The Second Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei,China;The Third Hospital of Hebei Medical University Shijiazhuang 050000,Hebei,China)
出处
《现代中西医结合杂志》
CAS
2019年第36期3999-4003,4016,共6页
Modern Journal of Integrated Traditional Chinese and Western Medicine
基金
河北省医学科学研究重点课题(ZD20140297)
关键词
脉搏氧灌注指数
老年人
全身麻醉
麻醉诱导
低血压
pulse oxygen perfusion index
elderly
general anesthesia
induction of anesthesia
hypotension
