CAJ | 학술논문

目的：探讨灌注变异指数（ PVI）对手术患者全麻诱导后低血压预测作用的评估。方法选取杭州市第三人民医院2012年9月至2013年10月择期全麻下手术患者106例，性别不限，年龄20～65岁，美国麻醉医师协会（ASA）Ⅰ～Ⅱ级，持续监测血压（BP）、心率（HR）、灌注指数（PI）和PVI，记录入室后麻醉前平卧位及头高30°位BP、HR、PI、PVI及麻醉诱导期间最低BP和HR。结果与术前平卧位及头高位比较，麻醉诱导后的 BP 和 HR发生明显下降；术前头高位PVI 与舒张压（DBP）和平均动脉压（MAP）降低百分比成一定相关性（r＝0．492、0．463， P＜0．05）；受试者工作特征曲线（ ROC）表明头高30°位PVI对麻醉诱导后低血压有一定预测作用，敏感度和特异度分别为67％和62％，而麻醉前平卧位PVI无预测作用。结论麻醉前头高30°位PVI在一定程度上对诱导后低血压有预测作用，有助于确定容易发生诱导后低血压的高危患者。
목적：탐토관주변이지수（ PVI）대수술환자전마유도후저혈압예측작용적평고。방법선취항주시제삼인민의원2012년9월지2013년10월택기전마하수술환자106례，성별불한，년령20～65세，미국마취의사협회（ASA）Ⅰ～Ⅱ급，지속감측혈압（BP）、심솔（HR）、관주지수（PI）화PVI，기록입실후마취전평와위급두고30°위BP、HR、PI、PVI급마취유도기간최저BP화HR。결과여술전평와위급두고위비교，마취유도후적 BP 화 HR발생명현하강；술전두고위PVI 여서장압（DBP）화평균동맥압（MAP）강저백분비성일정상관성（r＝0．492、0．463， P＜0．05）；수시자공작특정곡선（ ROC）표명두고30°위PVI대마취유도후저혈압유일정예측작용，민감도화특이도분별위67％화62％，이마취전평와위PVI무예측작용。결론마취전두고30°위PVI재일정정도상대유도후저혈압유예측작용，유조우학정용역발생유도후저혈압적고위환자。
Objective To evaluate the ability of pre-anesthesia pleth variability index ( PVI ) in supine and passive head raising ( PHR) position at 30°for predicting hypotension during induction of anesthesia.Methods From September 2012 to October 2013, 106 patients scheduled for elective surgery under general anesthesia at Third Hangzhou Municipal Hospital with American Society of AnesthesiologistsⅠ-Ⅱwere recruited.Pre-anesthesia values of blood pressure, heart rate, perfusion index, PVI in supine position and PHR at 30°were recorded.The minimum arterial blood pressure and minimum heart rate during anesthesia induction were recorded.Results Blood pressure and heart rate significantly decreased after induction.And the decline ratio of diastolic arterial blood pressure and mean arterial blood pressure were moderately correlated with pre-anesthesia PVI at 30°PHR position with Pearson′s coefficients of 0.492 and 0.463 respectively.The receiver-operating characteristic curve demonstrated that pre-anesthesia PVI in PHR at 30°position could predict hypotension during induction with a sensitivity of 67%and a specificity of 62%whereas pre-anesthesia PVI in supine position was non-reliable in predicting hypotension.Conclusion Pre-anesthesia PVI in PHR at 30°position may predict hypotension during induction with an acceptable accuracy.And this procedure is probably helpful for assessing high-risk patients susceptible to severe hypotension during induction.