末梢灌注指数与全身麻醉患者血流动力学及儿茶酚胺的相关性

目的 探讨末梢灌注指数(TPI)与血流动力学及儿茶酚胺的相关性,评价TPI在全麻应激监测中的价值和意义.方法 20例择期颅脑手术全麻患者,异丙酚和瑞芬太尼靶控诱导和维持,气管插管前和上头架前分别给予1次强直电刺激,记录诱导前(基础值)、电刺激前后、气管插管前后、电刺激前后和上头架前后TPI、收缩压(SBP)、舒张压(DBP)、心率(HR)和脑电双频指数(BIS),并计算每次应激前后各指标的最大变化值(△TPI、△SBP、△DBP和△HR).随机选择其中5例,在以上时间点采桡动脉测定肾上腺素(E)和去甲肾上腺素(NE).气管插管和上头架反应定为SBP高于基础值15 mm Hg(1 mm Hg=0.133 kPa).结果 △TPI与△SBP和△DBP正相关(r值分别为0.623和0.317,P值分别<0.01和0.05),而与AHR无相关性(P>0.05).电刺激后ATPI小于刺激前TPI10%的患者,气管插管和上头架反应显著减少.TPI与NE和E负相关(r值分别为-0.679和-0.364,P值分别<0.01和0.05).结论 (1)应激引起TPI变化与血压变化密切相关,而且电刺激后TPI变化对气管插管后和上头架后血压变化有一定预测作用.(2),TPI变化间接反映了血浆NE的水平.

Correlation of tip perfusion index with hemodynamics and catechalomines in patients undergoing general anesthesia

Objective To explore the correlation of tip perfusion index (TPI) with the hemodynamics and catechalomines and to assess the value and meaning of TPI for monitoring stress responses in general anesthesia. Methods Twenty patients who were to receive selective neurosurgery underwent induction and maintenance of propofol and remifentanil by target controlled infusion (TCI). A 60mA-5OHz5s electrostimulus was applied before tracheal intubation and head holder setting respectively. TPI, SBP,diastolic blood pressure (DBP), heart rate (HR), and bispectral index (BIS) were recorded at nine time points: before induction (baseline), before and after electrostimulation, before and after tracheal intubation, before and after electrostimulation, and before and after head holder setting. The changes of parameters (△TPI,△SBP,△DBP,△HR, and △BIS) were calculated after each stimulation. Five out of 20 patients were selected randomly to monitor the plasma concentration of catecholamine at the above time points. The responses to tracheal intubation and head holder setting were defined as the SBP increasing >15mm Hg over the baseline value. Results △TPI was significantly correlated with △SBP and △DBP (r=0.623 and 0.317, P<0.01 and 0.05). The responses to tracheal intubation and head holder setting were inhibited effectively when the △TPI caused by electrostimulus was less than 10% of the pre-electrostimulus TPI. TPI was significantly negatively correlated with the plasma Concentrations of norepinephrine and epinephrine (r=-0.679, and r=-0.364, P<0.05 and 0.O1). Conclusion (1)The TPI change is correlated well with the blood pressure change during stresses, and the TPI change caused by electrostimulus can predict the blood pressure change caused by tracheal intubation and head holder setting. (2) The TPI change reflects the norepinephrine plasma level indirectly.