采用灌注指数监测小儿全身麻醉期间伤害性刺激反应的临床观察
Clinical observation on perfusion index for detection of noxious stimuli in pediatric patients under#br# general anesthesia

目的· 观察灌注指数（perfusion index，PI）、脑电双频指数（bispectral index，BIS）、心率（heart rate，HR）、收缩压（systolic blood pressure，SBP）和呼吸频率（respiratory rate，RR）在小儿腹股沟斜疝手术期间牵拉刺激下的变化，探讨PI 监测应激反应的 应用价值。方法· 选择ASA Ⅰ～Ⅱ级择期行腹股沟斜疝修复术的患儿30 例。应用芬太尼、丙泊酚诱导，插入喉罩后七氟醚维持麻 醉。记录诱导前（T0）、牵拉疝囊前（T1）、牵拉即刻（T2）、牵拉后1 min（T3）和牵拉后5 min（T4）共5 个时点的PI、BIS、HR、 SBP 和RR。结果· 与T0 时点相比，T1、T3 和T4 时点PI 增高（P=0.000，P=0.033，P=0.000），T1 至 T4 时点的BIS、HR、SBP 降 低（均P=0.000）。与T1 时点比较，T2 和T3 时点PI 下降（P=0.000，P=0.025），T2 时点HR 增快（P=0.033），T3 和T4 时点SBP 增高 （P=0.000，P=0.011）， T2、T3 时点RR 增快（均P=0.000）。以PI 标准判断应激反应阳性的构成比（93.3%）高于HR（33.3%）、SBP （10.0%）和RR（43.3%）增幅为阳性的构成比（均P=0.000）。结论· PI 可迅速、灵敏地反映牵拉疝囊引起的伤害性刺激反应。
：Objective · To observe the changes of perfusion index (PI), bispectral index (BIS), heart rate (HR), systolic blood pressure (SBP) and respiratory rate (RR) under pulling stimuli in children undergoing open inguinal hernia repairs with spontaneous ventilation, so as to evaluate the clinical value of PI in monitoring the stress response. Methods · Thirty children undergoing selective open inguinal hernia repairs with American Society of Anesthesiologists (ASA) physical status I or II were recruited. Anesthesia was induced with fentanyl and propofol, and was maintained with sevoflurane after the insertion of laryngeal mask. The PI, BIS, HR, SBP and RR were observed at the following time points before induction of anesthesia (T0), before pulling hernia sac (T1), at the time point of pulling hernia sac (T2), 1 min after pulling hernia sac (T3) and 5 min after pulling hernia sac (T4). Results · Compared with the baseline level at T0, the PI value at T1, T3 and T4 increased significantly (P=0.000, P=0.033 and P=0.000, respectively). The BIS, HR and SBP values at T1-T4 were significantly lower than baseline levels at T0 (all P=0.000). The PI values at T2 and T3 reduced significantly compared with T1. The HR value at T2 was significantly higher than that of T1 (P=0.033). Compared with the SBP values at T1, the SBP values at T3 and T4 were significantly higher (P=0.000 and P=0.011, respectively). And the RR values at T2 and T3 were higher than that at T1 (both P=0.000). The proportion of children with positive stress response based on PI was significantly higher than that based on other variables (all P=0.000). Conclusion · Perfusion index can reflect the noxious stimuli of the pulling hernia sac effectively and immediately