第二部分伤害性刺激引起的末梢关注指数变化与血流动力学波动的相关.docVIP

末梢灌注指数用于麻醉中应激水平监测的研究 首都医科大学附属北京同仁医院，北京，（100730） 史婧 张炳熙 责任作者及联系方式：史婧；E-mail: caderyn@ 摘要 目的：本研究观察了全麻下气管插管刺激及切皮刺激对TPI及血流动力学参数的影响，探讨TPI用于监测术中应激引起的交感神经张力变化以及应激水平的可行性。方法：选取择期行全麻手术的患者30例，入室常规监测后依次静脉注射咪唑、芬太尼、维库溴胺、异丙酚进行诱导，静注维库溴胺后4min进行经口明示气管插管。选取入室安静平卧5min（T0），插管前（T1），插管后即刻、1min、2min、3min（T2 -T5），切皮前即刻（T6）、切皮即刻（T7）、切皮后1min、3min（T8 -T9）为时间点，记录各时间点BIS、TPI、MBP、HR。同时动态记录HR、TPI变化最大值以及最大值出现时间。结果：与基础值（T0）比较，插管前BIS、SBP、DBP 和HR都明显降低( P 0.01)，TPI明显增高（P0.01） ；与插管前（T1）比较，插管后（T2-T5）SBP、DBP、MBP和HR 显著升高( P 0.01) ,TPI明显降低（P0.01），BIS在插管前后都无显著变化；TPI与SBP、DBP、MBP、HR呈明显负相关。与切皮前（T6）比较，切皮后（T7 –T9）SBP、DBP、MBP和HR明显升高( P 0.01)，TPI明显降低（P0.01），BIS无显著变化。插管及切皮前后TPI变化幅度大于HR变化，且变化最大值出现时间较HR早。结论：TPI可以有效的用于监测术中应激引起的交感神经张力变化以及应激水平。 The study of Tip perfusion index monitoring the sympathetic tone during general anesthesia Abstract: Background: An evaluation of autonomic reactivity may help to predict circulatory responses to noxious stimulation. The relation between the tip perfusion index (TPI) and the circulatory responses immediately after endotracheal intubation and skin incision was examined to verify the feasibility of TPI for monitoring the changes of sympathetic tone and hemodynamic parameters by noxious stimulation during general anesthesia. Methods: Thirty adult patients, American Society of Anesthesiologists physical status I or II, aged 22–50 yr, weighing 57 ± 14 kg (mean ± SD), of both sexes undergoing general anesthesia were prospectively studied. General anesthesia was induced with fentanyl, modazolam, vecuronium and propofol. Tracheal intubation was performed four minutes after vecuronium injected. Anesthesia was maintained with nitrous oxide and sevoflurane. Before skin incision, the end-tidal concentration of sevoflurane was maintained at 1.3 MAC. The tip perfusion index(TPI) was monitored using HXD – I monitor ; systolic blood pressure(SBP), diastole blood pressure (DBP), mean blood pressure (MBP), heart rate (HR), SpO2 and End-tidal gas concentrations were measu