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目的探讨临床麻醉监测中如何通过指端光电容积脉搏波(PPG)的特异性变化来评估循环功能稳定性。方法骨伤科手术治疗患者600例,其中男性320例,女性280例;年龄26～84岁,平均年龄52岁。于麻醉前、麻醉成功后,以及不同失血量下,采用肱动脉血流阻断再通方法,人为改变被测指端血管内血流的压力和血流量,观察整个血流阻断再通过程中指端PPG峰形和波型的变化。结果依据血管弹性大小和小动脉张力大小其脉搏波呈现两种形态:锐峰和钝峰。循环系统功能稳定时,血流再通试验中前5个脉搏波峰高值(Y1～Y5)迅速恢复且波形相似(A型波);应激、失血等因素导致循环功能不稳定时,前5个脉搏波峰高值(Y1～Y5)大小变化不等且波形变异(B型波),指端PPG不同峰形-波型组合反映出不同的循环功能状态。结论手术麻醉监测中利用血流阻断再通试验,观察血流再通过程中指端PPG峰形和波型变化,不同峰形-波型组合变化,结合临床其他生命体征的监测指标,对于判断患者循环功能是否稳定、监测麻醉和手术对循环功能的影响程度,评估患者循环代偿能力的强弱具有重要的参考意义。
Objective To investigate how to evaluate the stability of circulatory function through the specific changes of finger photoplethysmography (PPG) in clinical anesthesia monitoring. Methods 600 cases were treated by orthopedic surgery, including 320 males and 280 females, aged from 26 to 84 years with a mean age of 52 years. Before anesthesia, after successful anesthesia, and different blood loss, using brachial artery blood flow blocking recanalization method, artificially change the pressure and blood flow of the measured end of the vessel blood flow to observe the entire blood flow through the block Changes in PPG peak and wave shape at the middle finger. Results According to the size of arterial elasticity and the size of arterioles, the pulse wave showed two forms: sharp peak and blunt peak. Circulatory system function is stable, the first five pulse wave peak value (Y1 ~ Y5) rapid recovery and waveform similar (A-wave) in the blood flow recanalization test; stress, blood loss and other factors lead to unstable circulatory function, the first 5 The pulse wave peak value (Y1 ~ Y5) varied in size and waveform variation (B wave), PPG finger peak different peak - wave combinations reflect different states of the circulatory function. Conclusions In the surgical anesthesia monitoring, the recanalization of blood flow was used to observe the change of PPG peak shape and wave shape, the change of different peak shape and wave pattern, and the monitoring indexes of other vital signs in the process of blood flow recanalization. The stability of patients with circulatory function, anesthesia and surgery to monitor the extent of the impact of circulatory function, assessment of the strength of patients with compensatory capacity of circulation has important reference value.