麻醉诱导插管前期收缩压和舒张压下降的时间过程：用逻辑函数建模

Time course of systolic and diastolic blood pressure decreases during the preintubation period of anesthesia induction: modeling with a logistic function.

作者信息

Mizuno Ju, Akune Tohru, Tsuda Takeshi, Fukui Yasuyuki, Otsuji Mikiya, Kin Nobuhide, Saito Yuichiro, Orii Ryo, Hayashida Masakazu, Arita Hideko, Hanaoka Kazuo

机构信息

Department of Anesthesiology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.

出版信息

J Clin Anesth. 2007 Nov;19(7):497-505. doi: 10.1016/j.jclinane.2007.04.002.

DOI:10.1016/j.jclinane.2007.04.002

PMID:18063203

Abstract

STUDY OBJECTIVE

To investigate whether systolic (SBP) and diastolic blood pressure (DBP) decreases during the preintubation period could be expressed as 4-parameter logistic and cubic functions giving S-shaped curves.

DESIGN

Prospective, clinical study.

SETTING

Operating room of a metropolitan general hospital.

PATIENTS

Seven ASA physical status I and II patients scheduled for elective spinal surgery during general anesthesia.

INTERVENTIONS

Anesthesia was induced with fentanyl, propofol, and vecuronium injection followed by inhalation of sevoflurane.

MEASUREMENTS

The SBP and DBP data were recorded at all beats from fentanyl injection to direct laryngoscopy. The respective changes were analyzed using a logistic function: P(t) = p(L) + (q(L) - p(L))/(1 + exp{[4 m(L)/(q(L) - p(L))][k(L) - t]}) and a cubic function: P(t) = at(3) + bt(2) + ct + d, where parameter p(L) is the upper asymptote, q(L) is the lower asymptote, m(L) is the slope at the inflection point, and k(L) is the time to the inflection point and where a, b, and c are coefficients, and d are constants. Goodness of fit of the two functions was compared using a correlation coefficient and residual mean squares. Each parameter was compared with the corresponding observed data.

MAIN RESULTS

Logistic correlation coefficient values for SBP and DBP decreases were larger than the cubic correlation coefficient values (0.990 [Z transformation: 2.64 +/- 0.32] vs 0.981 [Z: 2.32 +/- 0.37] and 0.977 [Z: 2.22 +/- 0.33] vs 0.967 [Z: 2.05 +/- 0.34], respectively; P < 0.05). Logistic residual mean squares values for SBP and DBP decreases were smaller than cubic residual mean squares values (20.6 vs 41.0 and 9.2 vs 13.7 mmHg(2), respectively; P < 0.05). There were significant correlations between p(L) and SBP or DBP after anesthesia induction, between q(L) and SBP or DBP before endotracheal intubation, and between k(L) and time to maximal rate of the SBP or DBP decrease (dP/dt(min)), but no significant correlation between m(L) and dP/dt(min) for SBP or DBP.

CONCLUSIONS

Time courses of SBP and DBP decreases during the preintubation period of anesthesia induction are modeled effectively by a logistic function.

摘要

研究目的

探讨麻醉诱导期收缩压（SBP）和舒张压（DBP）的下降是否可用呈现S形曲线的四参数逻辑函数和三次函数来表示。

设计

前瞻性临床研究。

地点

一家大城市综合医院的手术室。

患者

7例美国麻醉医师协会（ASA）身体状况为Ⅰ级和Ⅱ级、计划在全身麻醉下进行择期脊柱手术的患者。

干预措施

依次静脉注射芬太尼、丙泊酚和维库溴铵诱导麻醉，随后吸入七氟醚。

测量指标

记录从注射芬太尼至直接喉镜检查期间所有心搏的SBP和DBP数据。分别使用逻辑函数：P(t) = p(L) + (q(L) - p(L))/(1 + exp{[4 m(L)/(q(L) - p(L))][k(L) - t]})和三次函数：P(t) = at(3) + bt(2) + ct + d对相应变化进行分析，其中参数p(L)为上渐近线，q(L)为下渐近线，m(L)为拐点处斜率，k(L)为到达拐点的时间，a、b、c为系数，d为常数。使用相关系数和残差均方比较两个函数的拟合优度。将每个参数与相应的观察数据进行比较。

主要结果

SBP和DBP下降的逻辑相关系数值大于三次相关系数值（分别为0.990 [Z变换：2.64±0.32] 对0.981 [Z：2.32±0.37] 以及0.977 [Z：2.22±0.33] 对0.967 [Z：2.05±0.34]；P<0.05）。SBP和DBP下降的逻辑残差均方值小于三次残差均方值（分别为20.6对41.0以及9.2对13.7 mmHg(2)；P<0.05）。麻醉诱导后p(L)与SBP或DBP之间、气管插管前q(L)与SBP或DBP之间以及k(L)与SBP或DBP下降最大速率（dP/dt(min)）的时间之间存在显著相关性，但SBP或DBP的m(L)与dP/dt(min)之间无显著相关性。