指端光电容积脉搏波监测全麻患者伤害性应激反应的评价

发布时间：2018-03-03 20:18

本文选题：全麻　切入点：光电容积脉搏波　出处：《石河子大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:观察不同剂量芬太尼诱导时患者指端光电容积脉搏波的变化,评价指端光电容积脉搏波监测全麻诱导期伤害性应激反应的可行性和准确性。方法:择期全身麻醉下行手术、ASA分级I~II级、18~60岁的患者90人,患者入室平静10min后开始诱导,按诱导顺序应用咪达唑仑注射液0.05mg/kg,丙泊酚注射1.5mg/kg,当患者意识丧失,静脉推注顺阿曲库铵0.2mg/kg,根据麻醉诱导期芬太尼的用量随机分为三组(n=30):F4组芬太尼的剂量为4ug/kg;F5组芬太尼的剂量为5ug/kg;F6组芬太尼的剂量为6ug/kg,肌松完全后行气管插管,给予机械通气。分别于入室时(T1)、诱导后2min(T2)、插管即刻(气管插入声门10秒后)(T3)、插管后1min(T4)及插管后5min(T5)连续监测并记录患者心率(Heart rate,HR)、收缩压(Systolic blood pressure,SBP)、舒张压(Diastolic blood pressure,DBP)、血氧饱和度(SPO2)、手指温度、灌注指数(perfusion index,PI)和指端光电容积脉搏波并测量各项参数:指端光电容积脉搏波振幅(Photoplethysmograph pulse wave amplitude,PPGA),前倾角(α1),后倾角(α2),上升时间(t1),下降时间(t2)和脉动周期(Pulse beat interval,PBI),并在同时抽取肘静脉血4ml,用以测定血浆肾上腺素(epinephrine,E)及去甲肾上腺素(norepinephrine,NE)浓度。结果:与T1时刻相比,T2和T5时刻3组PPGA及PI升高,E和NE减小(P0.05),T3时刻F4组和F5组PPGA及PI降低,α2和NE升高(P0.01),F4组E升高(P0.05),F5组E无明显变化(P0.05)。F6组于T2、T3、T4和T5时刻PPGA和PI均升高,E和NE均减小(P0.01)。与T3时刻相比,T4和T5时刻F4组和F5组PPGA和PI增高,α2、E和NE降低(P0.05),F6组各指标均无明显变化(P0.05)。T1时刻各组之间各指标均无统计学意义(P0.05),T3和T4时刻F6组PPGA及PI明显高于F4组和F5组(P0.01),NE及E水平明显小于F4组和F5组(P0.01)。PPGA分别与E、NE呈负相关(P0.05),PI分别与HR、SBP、DBP、E、NE呈负相关(P0.05),α2分别与HR、SBP、DBP、NE呈正相关(P0.05),t2分别与HR、SBP、DBP、E、NE呈负相关(P0.05),PBI分别与HR、SBP、DBP、E、NE呈负关(P0.05)。结论:光电容积脉搏波参数PPGA、PI及α2可以无创、实时、有效的监测全身麻醉患者的伤害性应激反应,对指导临床麻醉用药有一定意义。
[Abstract]:Objective: to observe the changes of photovolumic pulse wave at the fingertip of patients induced by different doses of fentanyl. To evaluate the feasibility and accuracy of finger photovolumic pulse wave monitoring nociceptive stress response during induction of general anesthesia. Methods: 90 patients aged 1860 years old with ASA grade II or I grade were selected for general anesthesia. The patients were induced after 10 minutes of calm in the room. Midazolam injection 0.05 mg / kg, propofol 1.5 mg / kg, when the patient lost consciousness, According to the dosage of fentanyl during anesthesia induction period, three groups were randomly divided into three groups, the dosage of fentanyl was 4ugr / kg / kg fentanyl and the dosage of fentanyl in group F6 was 5ugr / kg / kg / kg fentanyl, and the tracheal intubation was performed after complete muscle relaxation. Mechanical ventilation. Continuous monitoring and recording of heart rate, heart rate, heart rate, systolic blood pressure-SBP, diastolic blood pressure, diastolic blood pressure, heart rate, heart rate, heart rate, heart rate, systolic blood pressure, diastolic blood pressure, diastolic blood pressure, heart rate, heart rate and heart rate at 2 min after induction, immediately after tracheal intubation (tracheal insertion at 10 seconds, 1 min after intubation, 1 min after intubation) and 5 min after intubation (5 min after intubation), respectively, in order to monitor and record the heart rate of the patients at the time of entering the room, 2 min after induction, 2 min after induction, 2 min after induction, 2 min after induction, and 2 min after induction. And SPO _ 2, finger temperature, Perfusion index perfusion index (Pi) and fingertip photovolumic pulse wave were measured and parameters were measured: the amplitude of finger photovolumic pulse wave photoplethysmograph pulse wave amplitudea PPGAA, antegrade angle (伪 1C), posterior inclination angle (伪 2N, rise time t 1N, drop time t 2) and pulsating period pulse beat intervale PBII, and simultaneously pumping. The plasma concentrations of epinephrine (E) and norepinephrinene (NE) in plasma were measured. Results: compared with T1 and T2 and T5, PPGA and Pi were increased, E and NE were decreased, PPGA and Pi were decreased in F4 group and F5 group, and 伪 2 and NE were decreased in F4 group and F5 group. There was no significant change in E in P0.05 and F5 groups. PPGA and Pi increased at the time of T2T3, T4 and T5. Compared with T3, PPGA and Pi of F4 and F5 were increased, and all indexes of 伪 2E and NE decreased in P0.05F6 and 伪 2E, NE were decreased in F4 and F5, but there was no obvious difference in each index between T4 and T5 and F5, and no significant difference was found in each index of 伪 2E and NE decrease in P0.05F6 group (P 0. 05P 0. 05 F6) compared with T 3, T 4 and T 5 were higher than that in T 4 and T 5. There was no significant difference between the indexes of each group at the time of P0.05T _ 1 and T _ 4. The levels of PPGA and Pi in the F6 group were significantly higher than those in the F4 group and the F5 group were significantly lower than those in the F4 group and the F5 group respectively. There was a positive correlation between P0.05, 伪 2 and DBPNE, respectively. There was a negative correlation between P0.05, P0.05, PBI and DBPnE, respectively. Conclusion: the parameters of optoelectronic volume pulse wave, PPGAP, Pi and 伪 2, are negative correlation P0.055.Conclusion: the parameters of optoelectronic volume pulse wave, PPGAP, Pi and 伪 2 can be noninvasive, and the correlation between P0. 05 and P0. 05 is negative correlation between P0. 05 and P0. 05. Conclusion: there is no significant difference between P0. 05 and P0. 05, P 0. 05. Monitoring the nociceptive stress response of patients with general anesthesia in real time and effectively has certain significance for guiding clinical anaesthesia.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614

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