脉搏灌注指数在评估老年男性患者低位硬膜外 麻醉阻滞效果中的应用

Value of pulse oximeter perfusion index in assessing the blocking effect of lower epidural anesthesia in elderly male patients

摘要:

目的：评估脉搏灌注指数（pulse oximeter perfusion index，PI）在判断老年男性患者低位硬膜外麻醉阻滞效果中的应用。方法：66例美国麻醉医师协会（American Society of Anesthesiologists，ASA）Ⅰ～Ⅲ级、年龄≥60岁的男性患者经硬膜外导管给予2%利多卡因后观察30 min，记录针刺皮肤测痛时双侧脚趾PI、针刺皮肤测痛时痛觉的变化以及提睾反射消失的时间。PI的变化率≥100%、痛觉及提睾反射消失考虑硬膜外麻醉阻滞有效。不同时刻PI的比较使用单因素重复测量方差分析，PI与提睾反射及针刺皮肤测痛预测硬膜外麻醉的成功率在各时刻点的比较使用配对四格表资料的卡方检验。结果：硬膜外腔给药后2 min PI逐渐增加，4 min痛觉开始减退，20 min提睾反射开始消失。在硬膜外腔给药后10、20及30 min各时刻点所有患者的PI均增加100%（P=0.000），针刺皮肤测痛的结果是0/66、45/66（χ2=24.973，P=0.000）、66/66，提睾反射消失的结果是0/66、51/66（ χ2=16.923，P=0.000）、66/66。结论：PI是评估老年男性患者低位硬膜外麻醉阻滞效果的早期、客观指标。

Abstract:

Objective：To investigate the value of pulse oximeter perfusion index（PI） in assessing the blocking effect of lower epidural anesthesia in elderly male patients. Methods：A total of 66 male patients aged ≥60 years with American Society of Anesthesiologists grade Ⅰ-Ⅲ were given 2% lidocaine via the epidural catheter and then observed for 30 minutes. The changes in PI and pain sensa－tion of the toes of both feet during needle prick and the time to the disappearance of cremasteric reflex were recorded. A PI change rate of ≥100% and the disappearance of pain sensation and cremasteric reflex were considered effective epidural blockage. A one-way analysis of variance with repeated measures was used for comparison of PI at different time points，and the chi-square test of paired fourfold data was used for comparison of the success rates of PI，cremasteric reflex，and pain measurement with needle prick in indicating epidural anesthesia at different time points. Results：PI gradually increased at 2 minutes after epidural administration and the pain with needle prick started to decrease at 4 minutes，and cremasteric reflex started to disappear at 20 minutes. At 10，20，and 30 minutes after epidural administration，all the patients achieved a 100% increase in PI（P=0.000）；0，45，and 66 patients，respec－tively，had no sense of pain during needle prick，and there was a significant increase in the number of patients from 10 to 20 min－utes（ χ2=24.973，P=0.000）；0，51，and 66 patients，respectively，had the disappearance of cremasteric reflex，and there was a signifi－cant increase in the number of patients from 10 to 20 minutes（χ2=16.923，P=0.000）. Conclusion：PI is an early and objective index of the blocking effect of lower epidural anesthesia in elderly male patients.