摘要
目的探讨手术体积描记指数(surgical pleth index,SPI)监测全凭静脉麻醉患者伤害性刺激的准确性以及对伤害性刺激心血管反应的预测性。方法择期甲状腺手术患者102例,年龄18~65岁,ASAⅠ~Ⅱ级,BMI 18.5~30 kg/m^(2)。每例患者均采用静脉麻醉诱导,靶控输注丙泊酚和瑞芬太尼麻醉维持,采用SPI行镇痛深度监测。记录患者伤害性刺激前2 min和伤害性刺激时SPI、心率(HR)、平均动脉压(MAP)的绝对值以及伤害性刺激后2 min内SPI、HR、MAP的最大值。采用受试者操作特征(receiver operating characteristic,ROC)曲线对SPI、HR、MAP监测伤害性刺激的准确性以及SPI对伤害性刺激心血管反应的预测性进行分析。结果根据ROC曲线分析,在监测气管插管刺激准确性方面,SPI[曲线下面积(area under roc curve,AUC)=0.931,最佳截断值=30]优于HR(AUC=0.804,最佳截断值=68)、MAP(AUC=0.759,最佳截断值=80),ΔSPI(AUC=0.990,最佳截断值=4)优于ΔHR(AUC=0.972,最佳截断值=3)、ΔMAP(AUC=0.854,最佳截断值=3),ΔSPI优于SPI,ΔHR优于HR,ΔMAP优于MAP,以上AUC差异均具有统计学意义(P<0.05);在监测切皮刺激准确性方面,SPI(AUC=0.925,最佳截断值=43)优于HR(AUC=0.587,最佳截断值=65)、MAP(AUC=0.804,最佳截断值=76),ΔSPI(AUC=0.998,最佳截断值=7)优于ΔHR(AUC=0.833,最佳截断值=1)、ΔMAP(AUC=0.943,最佳截断值=3),ΔSPI优于SPI,ΔHR优于HR,ΔMAP优于MAP,以上AUC差异均具有统计学意义(P<0.05);SPI对气管插管刺激心血管反应具有预测意义(AUC=0.662,最佳截断值=17,P<0.05),但对切皮刺激心血管反应不具有预测意义(P>0.05)。结论SPI绝对值与变化差值在监测伤害性刺激准确性方面均较优于传统的血流动力学指标HR、MAP,能对术中伤害性刺激进行更准确地监测;SPI对气管插管刺激心血管反应具有预测价值,对判断合适的插管时机具有重要的临床意义。
Objective To investigate the accuracy of surgical pleth index(SPI)in monitoring patients with nociceptive stimulation and its predictability for cardiovascular response to nociceptive stimulation in total intravenous anesthesia(TIVA).Methods A total of 102 patients(aged 18 to 65 years,ASAⅠtoⅡ,and BMI of 18.5 to 30 kg/m^(2))who underwent elective thyroid surgery in our hospital from February to June 2022 were enrolled in this study.Each patient was induced by intravenous anesthesia,maintained by target-controlled infusion of propofol and remifentanil,and monitored by SPI for analgesia depth.The absolute values of SPI,heart rate(HR)and mean arterical pressure(MAP)of patients 2 min before and during nociceptive stimulation and the maximum values of SPI,HR and MAP within 2 min after nociceptive stimulation were recorded.Receiver operating characteristic(ROC)curve was used to analyze the accuracy of SPI,HR and MAP in monitoring nociceptive stimulation and the predictability of SPI in cardiovascular response to nociceptive stimulation.Results ROC curve analysis indicated that SPI(AUC=0.931,Cutoff value=30)was superior to HR(AUC=0.804,Cutoff value=68)and MAP(AUC=0.759,Cutoff value=80)in monitoring accuracy of tracheal intubation stimulation,ΔSPI(AUC=0.990,Cutoff value=4)was better thanΔHR(AUC=0.972,Cutoff value=3)andΔMAP(AUC=0.854,Cutoff value=3),ΔSPI was better than SPI,ΔHR was better than HR,andΔMAP was better than MAP,with their AUC values statistically different(P<0.05).In terms of monitoring the accuracy of skin incisions,SPI(AUC=0.925,Cutoff value=43)was superior to HR(AUC=0.587,Cutoff value=65)and MAP(AUC=0.804,Cutoff value=76),ΔSPI(AUC=0.998,Cutoff value=7)was better thanΔHR(AUC=0.833,Cutoff value=1)andΔMAP(AUC=0.943,Cutoff value=3),ΔSPI was better than SPI,ΔHR was better than HR,andΔMAP was better than MAP,and the above AUC differences were statistically significant(P<0.05);SPI had predictive value for the cardiovascular response stimulated by tracheal intubation(AUC=0.662,Cutoff value=17,P<0.05
作者
刘华为
陈凤
丁锦屏
陈勤
左都坤
任玉坤
彭滔滔
段振馨
李洪
LIU Huawei;CHEN Feng;DING Jinping;CHEN Qin;ZUO Dukun;REN Yukun;PENG Taotao;DUAN Zhenxin;LI Hong(Department of Anesthesiology,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China)
出处
《陆军军医大学学报》
CAS
CSCD
北大核心
2022年第17期1757-1763,共7页
Journal of Army Medical University
基金
国家重点研发计划(2018YFC0117200)。
关键词
手术体积描记指数
伤害性刺激
全凭静脉麻醉
surgical pleth index
nociceptive stimulation
total intravenous anesthesia
