CAJ | 학술논문

目的：通过观测不同手术刺激下指光电容积脉搏波（ finger photoelectric plethysmography，FPPG）变化的情况，探讨运用FPPG进行围术期伤害性感受监测的可行性。方法选择择期行乳腺癌根治术患者60例，ASAⅠ-Ⅱ级，女性，年龄20～60岁；依据不同手术刺激将其分为3组（n＝20）：S1组（超声刀组）、S2组（电刀组），S3组（钳夹组）。麻醉诱导后完成气管内插管，并行机械通气，麻醉中常规监测心电图（ ECG）、血氧饱和度（ SpO2）、呼气末二氧化碳分压（ETCO2）、收缩压（SBP）、舒张压（DBP）、心率（HR）。于手术开始后5 min（T1）、10 min （T2）、15 min （T3）分别给予超声刀、电刀、钳夹刺激，采集手术切皮前（T0）及各点刺激前后患者FPPG信号，各时点描记光电容积指脉搏波形30 s，数据进行离线分析。结果3组T1、T2、T3时刻刺激前后脉搏波幅度均减小（ P＜0．05）且幅度随刺激强度而改变。 S1组SBP在各点刺激后均升高（P＜0．05），S2组SBP在T1时刻刺激后升高（P＜0．05）。 DBP、HR变化均无统计学意义。结论围术期伤害性刺激反应和指光电容积脉搏波波幅（photoe-lectric plethysmography amplitude，PPGA）变化有一对一的关系。随伤害性刺激强度增大，围术期光电容积指脉搏波变化幅度增大，应激性刺激反应程度增强；FPPG可能成为一种潜在的新型围术期伤害性刺激反应的实时、不间断性监测方法。
목적：통과관측불동수술자격하지광전용적맥박파（ finger photoelectric plethysmography，FPPG）변화적정황，탐토운용FPPG진행위술기상해성감수감측적가행성。방법선택택기행유선암근치술환자60례，ASAⅠ-Ⅱ급，녀성，년령20～60세；의거불동수술자격장기분위3조（n＝20）：S1조（초성도조）、S2조（전도조），S3조（겸협조）。마취유도후완성기관내삽관，병행궤계통기，마취중상규감측심전도（ ECG）、혈양포화도（ SpO2）、호기말이양화탄분압（ETCO2）、수축압（SBP）、서장압（DBP）、심솔（HR）。우수술개시후5 min（T1）、10 min （T2）、15 min （T3）분별급여초성도、전도、겸협자격，채집수술절피전（T0）급각점자격전후환자FPPG신호，각시점묘기광전용적지맥박파형30 s，수거진행리선분석。결과3조T1、T2、T3시각자격전후맥박파폭도균감소（ P＜0．05）차폭도수자격강도이개변。 S1조SBP재각점자격후균승고（P＜0．05），S2조SBP재T1시각자격후승고（P＜0．05）。 DBP、HR변화균무통계학의의。결론위술기상해성자격반응화지광전용적맥박파파폭（photoe-lectric plethysmography amplitude，PPGA）변화유일대일적관계。수상해성자격강도증대，위술기광전용적지맥박파변화폭도증대，응격성자격반응정도증강；FPPG가능성위일충잠재적신형위술기상해성자격반응적실시、불간단성감측방법。
Objective To evaluate the feasibility of nociception monitoring of patients in perioperative period through observing the changes in finger photoplethysmography ( FPPG) after different surgical stimulations.Methods A total of 60 ASA I-II female patients aged from 20 to 60 years old were included into the current study, who underwent breast cancer operation.They were divided into three groups according to different surgical stimulations ( n=20):a har-monic scalpel group (S1), an electrotome group (S2) and a forceps clip group (S3).The CSI was maintained between 40 to 60.Then, ECG, SPO2 , ETCO2 , SBP, DBP and HR were monitored during anesthesia.The changes of finger pho-toelectric plethysmography ( FPPG) were recorded from right index finger of the patients at the following time points:be-fore surgical incision (T0), 5 min after surgical incision (T1) with stimulation of harmonic scalpel, 10 min after surgical incision (T2) with stimulation of electrotome, and 15 min before surgical incision (T3) with stimulation of forceps clip. The data obtained were adopted for offline analysis.Results After stimulation, all groups presented reduced FPPG am-plitudes at T1, T2 and T3 (P<0.05), while the amplitudes were increased as stimulation enhanced.The S1 group pro-duced higher SBP at each time points, while the S2 group produced higher SBP at T1 (P<0.05).No statistical differ-ence was seen as to the changes of HR and DBP.Conclusion Nociception in perioperative period is associated with PPG amplitudes.The stronger nociception is, the larger PPG amplitudes are.PPG is a potential method to monitor noci-ception in perioperative period.