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Pleth变异性指数与剖宫产腰硬联合麻醉后低血压相关性研究
The correlation of Pleth variability index with hypotension after Combined Spinal Epidural Anesthesia for cesarean section.
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DOI:
作者:
陈秀斌 朱慧琛 忻纪华 陈杰
Chen Xiubin, Zhu Huichen, Xin Jihua, Chen Jie
作者单位:
上海交通大学医学院附属仁济医院
Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
关键词:
Pleth变异性指数(PVI);剖宫产;腰硬联合麻醉
Pleth variability index(PVI);Cesarean section;Combined Spinal Epidural Anesthesia(CSEA)
摘要:
目的:探讨麻醉前Pleth 变异性指数 (PVI)与腰硬联合麻醉(CSEA)后剖宫产低血压发生的关系。方法:选取ASAⅠ-Ⅱ级足月择期剖宫产患者50例。产妇入手术室平稳呼吸5分钟后,检测血压、心率、PI、PVI值。以等比重0.75%盐酸罗哌卡因1.5ml行CSEA麻醉,麻醉后的15分钟内,每2.5分钟测量血压和心率。根据是否发生低血压分为低血压组(I组)和正常血压组(Ⅱ组)。结果:50例患者中,I组23例,Ⅱ组27例。两组患者年龄、身高、体重、孕周、新生儿体重均无显著差异。麻醉前基础血压和心率亦无显著差异,I组麻醉前PVI值(22.61±4.92)明显高于Ⅱ组(15.48±3.33,P<0.001)。PVI与麻醉后收缩压、舒张压、平均动脉压变化最大值及心率变化最大值的关联系数分别为-0.590,-0.502,-0.651和-0.113。麻醉后SBP、DBP、MAP变化最大值与麻醉前PVI呈负相关,而HR则未显示出与PVI有关。以PVI>18.5作为发生低血压的界值,其敏感度为0.87,特异度为0.852。结论:麻醉前PVI值可预测剖宫产腰硬联合麻醉后低血压的发生。
Object: To investigate the relationship between Pleth variability index (PVI) and the hypotension after combined spinal-epidural anesthesia for cesarean section. Methods: Fifty ASAⅠor Ⅱparturients selected cesarean section were enrolled in the study. After arrived in the operation room and smooth and steady breathe 5 minutes,the parturients, PVI, heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were measured. CSEA was induced with isobaric 0.75% ropivacaine 1.5ml. During the 15 minutes after anesthesia, SBP、DBP、MAP、HR were measured per 2.5min. Results: In the 50 parturients, 23 of which were occurred with hypotension(groupⅠ), the others remain the normal blood pressure(groupⅡ). There were no significant differences in baseline SBP、DBP、MAP and HR between the two groups. The PVI in groupⅠ(22.61±4.92) is significant higher than groupⅡ(15.48±3.33,P<0.001). Linear regression analysis that compared pre-anesthesia PVI with the maximum variations in SBP、DBP、MAP and HR yielded an r value of -0.590,-0.502,-0.651和-0.113 respectively. With PVI>18.5 as the occurrence of hypotension in the limit, the sensitivity was 0.87, specificity was 0.852. Conclusion: PVI can predict the occurrence of hypotension after combined spinal-epidural anesthesia in cesarean section.
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