CAJ | 학술논문

目的：通过脉搏灌注变异指数（ perfusion variability index ，PVI）评估蛛网膜下腔阻滞麻醉对妇科患者输液量的影响，并得出相应的计算公式指导临床。方法选择100例择期行妇科开腹手术患者。体重指数（body mass index，BMI）在18．5～24之间。 ASA为Ⅰ～Ⅱ级。入室后记录PVI的值，并按7 mL／kg液体量预扩容，滴注速率为每小时20 mL? kg－1。预扩容后实施麻醉。选择L3～4间隙，0．5％布比卡因0．2 mg／kg重比重溶液，以0．2 mL／s的速度推注。麻醉后PVI值逐渐升高，加快输液使患者PVI值恢复到入室范围以保证有效血容量的稳定，记录使PVI恢复至入室水平时的输液量和患者的预扩容量，及PVI最高值与入室时PVI之间的差值，表示为ΔPVI。结果100例妇科开腹手术患者蛛网膜下腔阻滞过程中，输液量与体重之间存在正相关性，患者体重增加输液量也增加；输液量与ΔPVI存在正相关性，ΔPVI越大，输液量亦越大；对输液量Y与X1（体重）、X2（ΔPVI）进行回归分析，P＜0．05，方程为Y＝9．55 X1＋13．59 X2＋145．44。结论脉搏灌注变异指数的变化率对蛛网膜下腔阻滞的输液量有极明显的指导意义。
목적：통과맥박관주변이지수（ perfusion variability index ，PVI）평고주망막하강조체마취대부과환자수액량적영향，병득출상응적계산공식지도림상。방법선택100례택기행부과개복수술환자。체중지수（body mass index，BMI）재18．5～24지간。 ASA위Ⅰ～Ⅱ급。입실후기록PVI적치，병안7 mL／kg액체량예확용，적주속솔위매소시20 mL? kg－1。예확용후실시마취。선택L3～4간극，0．5％포비잡인0．2 mg／kg중비중용액，이0．2 mL／s적속도추주。마취후PVI치축점승고，가쾌수액사환자PVI치회복도입실범위이보증유효혈용량적은정，기록사PVI회복지입실수평시적수액량화환자적예확용량，급PVI최고치여입실시PVI지간적차치，표시위ΔPVI。결과100례부과개복수술환자주망막하강조체과정중，수액량여체중지간존재정상관성，환자체중증가수액량야증가；수액량여ΔPVI존재정상관성，ΔPVI월대，수액량역월대；대수액량Y여X1（체중）、X2（ΔPVI）진행회귀분석，P＜0．05，방정위Y＝9．55 X1＋13．59 X2＋145．44。결론맥박관주변이지수적변화솔대주망막하강조체적수액량유겁명현적지도의의。
Objective To evaluate the guiding role of perfusion variability index ( PVI) on ef-fective circulating blood volume in patients undergoing gynecological open surgery and spinal anesthesia .Methods One hundred females ( BMI 18.5~24 kg/m2 , ASAⅠ~Ⅱ) undergo-ing elective gynecological open surgery were recruited .Once the patients arrived at the opera-tion room, values of PVI were recorded and defined as PVI 1.Then 7 mL/kg of fluid were in-fused for volume expansion at the rate of 20 mL ( kg? h-1 ) .The volume expansion was fol-lowed by spinal anesthesia .The puncture point chosed was the space between L 3~4 .When successful puncture was administered , the patients were given 0.5%bupivacaine 0.2 mg/kg at the rate of 0.2 mL/s head forward .After anesthesia PVI increased gradually , and the maximal value were recorded as PVI2.At this moment, rapid fluid infusion was necessary to approxi-mate PVI at PVI1 to ensure the stability of effective blood volume .The fluid volume used for expansion and the infused volume aiming at maintaining PVI were recorded respectively .Re-sults There was positive correlation between the infused fluid volume and body weight during spinal anesthesia .The higher body weight , the more fluid was infused .Positive correlation also existed between the infused fluid volume and ΔPVI.The larger ΔPVI, the more fluid was in-fused.Regression analysis was proceeded for the infused fluid volume (Y), body weight (X1) and ΔPVI ( X2 ) , and there was significance to the regression equation , which was Y=9.55 X1+13.59 X2 +145.44 .Conclusion Change rate of PVI has great guiding significance to infu-sion volume under spinal anesthesia .