国际麻醉学与复苏杂志   2012, Issue (7): 7-7
    
末梢灌注指数判断儿童氯胺酮基础麻醉下硬膜外试验剂量注入血管的有效性研究
徐子锋, 郑吉建, 沈浩, 李金宝, 邓小明1()
1.上海市第一人民医院麻醉科
The efficacy of perfusion index as an indicator for intravascular injection of epinephrine-containing epidural test dose in ketamine-anesthetized children
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摘要：

目的 末梢灌注指数（perfusion index，PI）是一种无创监测末梢组织灌注的指标，本文研究在儿童氯胺酮基础麻醉中，PI变化能否作为判断利多卡因试验剂量(内含肾上腺素5 mg/L)注入血管的有效指标。方法 40例美国麻醉医师协会（ASA)I级，2岁~8岁行下腹，下肢或会阴部择期手术的患儿，采用完全随机分组法分为对照组、试验组两组，每组20例，静脉注入咪达唑仑0.05 mg/kg和2 mg/kg氯胺酮作为基础麻醉，15 min后对照组静注0.1 ml/kg生理盐水，试验组静注0.1 ml/kg 1%利多卡因（内含肾上腺素5 mg/L），最大剂量为3 mL，注药速度为0.4 mL/s,模拟硬膜外利多卡因试验剂量(内含肾上腺素5 mg/L)注入血管。分别记录注药前和注药后3 min内的心率（heart rate, HR），收缩压（systolic blood pressure，SBP）,T波振幅（T-wave amplitude，TWA）和PI。结果 对照组静注生理盐水后各项监测指标无统计学显著差异。试验组注射利多卡因（内含肾上腺素5 mg/L）后TWA、SBP、HR和PI较注药前显著变化。其中TWA和HR最大增幅出现在给药后20 s。TWA较注药前增加了（23.05±11.74）%，HR增加了（34.90 ±6.46）次/min。注药后PI值明显下降，40 s时最大降幅为(61.4 ±11.6)%。SBP最大增幅出现在注药后60 s，较注药前增加了(19±9)mm Hg(1 mm Hg=0.133kPa)。PI下降30%作为判断试验剂量误入血管的阳性指标，其敏感度，特异度，阳性和阴性预测值均为100%。 结论 儿童氯胺酮基础麻醉下，PI是一种早期判断硬膜外试验剂量注入血管的有效监测指标，PI联合HR，SBP和TWA指标更有效地判断硬膜外试验剂量注入血管。
关键词： 氯胺酮；基础麻醉；硬膜外试验剂量；灌注指数
Abstract:

Objective Perfusion index (PI) is a noninvasive numerical value of peripheral perfusion obtained from a pulse oximeter. In this study, we evaluated the efficacy of PI for detecting intravascular injection of a simulated epidural test dose containing epinephrine in children during ketamine-based anesthesia. Methods Forty pediatric patients ASAⅠ, 2-8 years,male,scheduled for elective surgery under ketamine basal anesthesia were randomized to receive either 0.1 ml/kg of 1% lidocaine with epinephrine 5 mg/L or 0.1 mL/kg of saline IV (n=20 each).to simulate an accidental intravascular test dose. HR, SBP, TWA and PI were monitored for 3 min after injection. Results Injecting the test dose resulted in an average maximum PI decrease by (61.4±11.6)% at 40 s. Moreover, maximal increases in HR (35±6)bpm , SBP[(19±10)mm Hg(1 mm Hg=0.133kPa)]and TWA [(23.05 ±11.74)%]were(35±6)bpm at 20 s,60s and 20 s after test dose injections, respectively. Using the PI criterion for intravascular injection (positive if PI decreases≥30% from the preinjection value) the sensitivity, specificity, positive predictive, and negative predictive values were 100%. Conclusions PI is a reliable alternative to conventional hemodynamic criteria for detection of an intravascular injection of epidural test dose in ketamine-anesthetized pediatric patients.
Key words: Ketamine；Basal anesthesia；Epidural test dose；Perfusion index