摘要
目的对光电容积血流脉搏波描记(PPG)信号提取的特征参数在麻醉手术中监测应激反应的可行性进行评估。方法选择清宫术或宫腔镜辅助下分段诊断性刮宫手术病人60例,ASAⅠ～Ⅱ级,年龄20～48岁。在喷他佐辛复合丙泊酚静脉麻醉下手术。分别于麻醉诱导前(T0)、麻醉诱导后(T1)、宫腔操作刺激时(T2)、手术刺激停止后(T3)4个时点采集病人左手食指端PPG信号,每次持续描记1 min;同时记录心率(HR)、血压(BP)、平均动脉压(MAP)和心率血压乘积(HRPP)、脑电双频谱指数(BIS)。采用"面积重心位移分析方法"从PPG信号中提取整个脉动周期的血容量均值(Qmean0),以及血管充盈期血容量均值(Qmean1)和血管回缩期血容量均值(Qmean2),由Qmean2/Qmean1生成生物学标记回缩充盈分数(CDF),分别对各指标不同时点绘制折线图观察变化趋势,并做统计学分析。结果 CDF和Qmean2变化与手术刺激高度相关联;CDF与Qmean2在手术刺激时各点前后比较差异有显著统计学意义(P<0.01),但Qmean2的t绝对值均小于CDF的对应t;趋势图显示CDF和Qmean2于T1时点较T0时点明显降低,T2时点突然增高,但未高过T0时点水平,T3时点再度回降。Qmean0和Qmean1在整个过程中波动较小。HR、SBP、DBP、MAP和HRPP显示出较大的共性,于T1时点较T0时点明显降低,T2时点继续下降,T3时点相对于T2时点无明显变化,结合BIS趋势图变化分析,提示常规指标主要受到麻醉深浅程度影响,而并非术中伤害性刺激反应,且对麻醉深浅程度的反映相对BIS略显滞后。结论尽管静脉麻醉药有效调控了手术应激反应并保持了术中BP、HR等指标的平稳,然而通过指端PPG信号中提取的生物学标记仍可以测量出术中伤害性刺激引发的末梢循环明显变化,且两者之间存在显著的正向关联性。
Objective To assess the feasibility of stress reaction monitoring with characteristic parameters derived from photoplethysmographic（PPG） signals throughout anesthesia and surgery.Methods Sixty patients with scheduled for curettage or hysteroscopy and dilatation and curettage under pentazocine and propofol intravenous anesthesia were enrolled,ASA Ⅰ-Ⅱ,aged 20-48 years old.PPG signals were recorded non-invasively from the left index fingers of subjects at 4 times： before anesthesia induction（T0）,after induction anesthesia（T1）,uterine stimulation operation（T2） and after cessation of stimulation operation（T3）,1 minute each time.Heart rate（HR）,blood pressure（BP）,mean arterial pressure（MAP）,heart rate-pressure product（HRPP） and bispectral index（BIS） were also recorded.The area barycenter displacement analytical method of pulse wave was employed as an approach to derive parameters and biomarkers from PPG signals.The mean value of the blood volume contour during the pulse beat interval（Qmean0）,vasodilatation phase（Qmean1） and vasoconstriction phase（Qmean2） were derived as original characteristic parameters.The ratio of Qmean2/Qmean1 was captured as a biomarker vasoconstriction vasodilation fraction（CDF）.Mean value and standard deviation of parameters and biomarker were collected at T0,T1,T2 and T3,the varying trend was traced and statistically analyzed.Results A high degree associated was showed between CDF and Qmean2 and surgical stimulation.T-test results of CDF and Qmean2 before and after surgery were significant difference.An fluctuation of both CDF and Qmean2 was detected in obvious decreased from T0 to T1,a significant increase from T1 to T2 but not as high as T0,and a significant decease again from T2 to T3.There was no significant change in Qmean0 and Qmean1.The trend of conventional indices（HR,SBP,DBP,MAP and HRPP） was detected： significant decrease from T0 to T1,and from T1 to T2;no significant change was observed from T2 to T3.The conventional indices were significantly related to the depth of general anesthesia but not the response to surgery.Conclusion Although the response to stimulation is effectively controlled and the conventional indices including HR and BP remaine stable under intravenous anesthesia,the biomarkers extracted from the PPG signals in finger tip may detect the circulatory changes caused by harmful stimulations during surgery.Significant positive correlation between each other.
出处
《生物医学工程与临床》
CAS
2011年第6期533-538,共6页
Biomedical Engineering and Clinical Medicine
