基于光電容積指脈搏波預測擇期剖宮產腰麻后低血壓的研究
發(fā)布時間：2019-02-18 15:00
【摘要】：背景： 腰麻(spinal anesthesia)因其起效迅速、麻醉效果可靠,是剖宮產麻醉中最常用的區(qū)域阻滯麻醉技術。低血壓(hypotension)是腰麻的最常見并發(fā)癥,其機制主要是交感神經節(jié)前纖維阻滯后系統(tǒng)血管阻力的下降以及血液積聚于軀體阻滯部位引起的心輸出量的減少。妊娠使交感神經張力增高,妊娠子宮對下腔靜脈的壓迫使回心血量進一步減少,故而孕婦更易發(fā)生腰麻后低血壓。腰麻后低血壓對母嬰均具有潛在的不良影響。年齡,體重指數(shù)(BMI),交感神經基礎張力,外周血管阻力等均可影響腰麻后低血壓的程度。 光電容積脈搏波(photoplethysmographic pulse wave, PPGPW)是根據外周微血管的血液容積隨心臟搏動而產生的脈動性變化,通過光電容積描記法(photolethtysmography, PPG)獲得的周期性的波形,包含血流動力學、心搏功能、微循環(huán)病理生理、植物神經功能等諸多生理信息。因此,我們推定光電容積脈搏波特征參數(shù)或許可以用來預測剖宮產腰麻后低血壓風險。 目的： 通過分析光電容積脈搏波特征參數(shù)與發(fā)生腰麻后低血壓之間的相關性,建立剖宮產腰麻后低血壓風險的預測模型,用于指導臨床低血壓的預防。 方法： 選擇擇期行剖宮產的20-40歲足月健康孕婦(ASA1-2級)69例。所有病人麻醉前均給予快速靜脈輸注500ml羥乙基淀粉130/0.4(萬汶)。采用左側臥位,與L3-4或L4-5間隙穿刺人蛛網膜下腔,注入重比重羅哌卡因15mg�？刂谱铚矫嬖赥4-5。記錄病人的一般情況,血流動力學數(shù)據,胎兒情況,通過計算機實時連續(xù)記錄光電容積指脈搏波波形并且提取手術前一天(DBS),手術當天預擴容前(DOS-BP),手術當天預擴容后至麻醉前(DOS-AP),麻醉后一分鐘(SBA+1)的波形特征參數(shù),通過多因素logic回歸分別建立預測模型,選取最佳模型,并通過ROC曲線選取閾值,計算敏感性和特異性。 結果： 手術前一天(DBS)基于光電容積脈搏波特征參數(shù)建立的預測模型預測效果最好,AUC為0.8259,其95%CI為0.7285-0.9232,預測效果良好。預測模型表現(xiàn)式為log it(π)=8.8076+0.2363AGE-0.3819BMI-0.2539PPGA-0.4723ARD+0.3940ART,當以概率0.61為閾值時,敏感度為72.50%,特異性為72.41%。 結論： 基于術前一天光電容積脈搏波特征參數(shù)建立的預測模型可以較好的預測擇期剖宮產腰麻后低血壓的風險。
[Abstract]:Background: spinal anesthesia (spinal anesthesia) is the most commonly used area block anesthesia technique in cesarean section because of its rapid onset and reliable anaesthesia effect. Hypotension (hypotension) is the most common complication of spinal anesthesia. Its mechanism is the decrease of systemic vascular resistance after sympathetic preganglionic fiber block and the decrease of cardiac output caused by blood accumulation in somatic block. The tension of sympathetic nerve was increased in pregnancy, and the pressure of pregnancy uterus on inferior vena cava decreased the volume of return heart blood further, so pregnant women were more likely to develop hypotension after spinal anesthesia. Hypotension after spinal anesthesia has potential adverse effects on mothers and infants. Age, body mass index (BMI), basic tension of sympathetic nerve and peripheral vascular resistance can affect the degree of hypotension after spinal anesthesia. Optoelectronic volume pulse wave (photoplethysmographic pulse wave, PPGPW) is a periodic waveform obtained by photoelectric plethysmography (photolethtysmography, PPG) based on the pulsating changes of blood volume of peripheral microvessels with cardiac pulsation, including hemodynamics. Cardiac function, microcirculation pathophysiology, autonomic nerve function and many other physiological information. Therefore, we presume that the photovolumic pulse wave characteristic parameters may be used to predict the risk of hypotension after cesarean section. Objective: to establish a predictive model for predicting the risk of hypotension after spinal anesthesia by analyzing the correlation between the characteristic parameters of photovolumic pulse wave and hypotension after spinal anesthesia in order to guide the prevention of clinical hypotension. Methods: 69 healthy pregnant women aged 20-40 (ASA1-2 grade) were selected for elective cesarean section. All patients were given rapid intravenous infusion of 500ml hydroxyethyl starch 130 / 0.4 before anesthesia. The left decumbent position was used to puncture the subarachnoid space between L3-4 or L4-5, and 15 mg of ropivacaine was injected into the subarachnoid space. The control block level was T4-5. Record the patient's general condition, hemodynamic data, fetal condition, record the pulse wave waveform of photoelectric volume finger by computer in real time and extract the pre-dilatation (DOS-BP) day before (DBS), operation. The waveform characteristic parameters of pre-dilatation before anesthesia (DOS-AP) and one minute after anesthesia (SBA _ 1) on the day of operation were analyzed. The prediction model was established by multi-factor logic regression, the best model was selected, and the threshold value was selected by ROC curve. Computational sensitivity and specificity. Results: on the day before operation, the prediction model based on the characteristic parameters of photovolumic pulse wave in (DBS) was the best, the AUC was 0.8259, its 95%CI was 0.7285-0.9232, and the prediction effect was good. The expression of the predictive model is log it (蟺) = 8.8076 0.2363AGE-0.3819BMI-0.2539PPGA-0.4723ARD 0.3940ART. When the threshold value is 0.61, the sensitivity is 72.50 and the specificity is 72.41. Conclusion: the prediction model based on the characteristic parameters of photovolumic pulse wave can predict the risk of hypotension after selective cesarean section.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614
本文編號：2425955
[Abstract]:Background: spinal anesthesia (spinal anesthesia) is the most commonly used area block anesthesia technique in cesarean section because of its rapid onset and reliable anaesthesia effect. Hypotension (hypotension) is the most common complication of spinal anesthesia. Its mechanism is the decrease of systemic vascular resistance after sympathetic preganglionic fiber block and the decrease of cardiac output caused by blood accumulation in somatic block. The tension of sympathetic nerve was increased in pregnancy, and the pressure of pregnancy uterus on inferior vena cava decreased the volume of return heart blood further, so pregnant women were more likely to develop hypotension after spinal anesthesia. Hypotension after spinal anesthesia has potential adverse effects on mothers and infants. Age, body mass index (BMI), basic tension of sympathetic nerve and peripheral vascular resistance can affect the degree of hypotension after spinal anesthesia. Optoelectronic volume pulse wave (photoplethysmographic pulse wave, PPGPW) is a periodic waveform obtained by photoelectric plethysmography (photolethtysmography, PPG) based on the pulsating changes of blood volume of peripheral microvessels with cardiac pulsation, including hemodynamics. Cardiac function, microcirculation pathophysiology, autonomic nerve function and many other physiological information. Therefore, we presume that the photovolumic pulse wave characteristic parameters may be used to predict the risk of hypotension after cesarean section. Objective: to establish a predictive model for predicting the risk of hypotension after spinal anesthesia by analyzing the correlation between the characteristic parameters of photovolumic pulse wave and hypotension after spinal anesthesia in order to guide the prevention of clinical hypotension. Methods: 69 healthy pregnant women aged 20-40 (ASA1-2 grade) were selected for elective cesarean section. All patients were given rapid intravenous infusion of 500ml hydroxyethyl starch 130 / 0.4 before anesthesia. The left decumbent position was used to puncture the subarachnoid space between L3-4 or L4-5, and 15 mg of ropivacaine was injected into the subarachnoid space. The control block level was T4-5. Record the patient's general condition, hemodynamic data, fetal condition, record the pulse wave waveform of photoelectric volume finger by computer in real time and extract the pre-dilatation (DOS-BP) day before (DBS), operation. The waveform characteristic parameters of pre-dilatation before anesthesia (DOS-AP) and one minute after anesthesia (SBA _ 1) on the day of operation were analyzed. The prediction model was established by multi-factor logic regression, the best model was selected, and the threshold value was selected by ROC curve. Computational sensitivity and specificity. Results: on the day before operation, the prediction model based on the characteristic parameters of photovolumic pulse wave in (DBS) was the best, the AUC was 0.8259, its 95%CI was 0.7285-0.9232, and the prediction effect was good. The expression of the predictive model is log it (蟺) = 8.8076 0.2363AGE-0.3819BMI-0.2539PPGA-0.4723ARD 0.3940ART. When the threshold value is 0.61, the sensitivity is 72.50 and the specificity is 72.41. Conclusion: the prediction model based on the characteristic parameters of photovolumic pulse wave can predict the risk of hypotension after selective cesarean section.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614
【參考文獻】
相關期刊論文 前1條
1 楊琳;張松;楊益民;羅志昌;;基于重搏波谷點的脈搏波波形特征量分析[J];北京生物醫(yī)學工程;2008年03期
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