腹腔镜胆囊切除术期间的脉搏光体积描记振幅和心率变异性：一项前瞻性观察研究。

Pulse photoplethysmographic amplitude and heart rate variability during laparoscopic cholecystectomy: A prospective observational study.

机构信息

From the Azienda Ospedaliera Luigi Sacco, Polo Universitario, University of Milan, Milan (RC, AC, BB, SP, PB, TF, SG), Istituto Clinico Humanitas IRCCS, Rozzano (FR), Azienda Ospedaliera Luigi Sacco, Polo Universitario, University of Milan, Milan (RC, AC, BB, SP, PB, TF, SG), Istituto Clinico Humanitas IRCCS, Rozzano (AM), Azienda Ospedaliera Luigi Sacco, Polo Universitario (RC, AC, BB, SP, PB, TF, SG), Department of Biomedical Sciences for Health, University of Milan; Department of Cardiothoracic, Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San DonatoSan Donato Milanese, Milan, Italy (AP).

出版信息

Eur J Anaesthesiol. 2017 Aug;34(8):526-533. doi: 10.1097/EJA.0000000000000660.

DOI:10.1097/EJA.0000000000000660

PMID:28617680

Abstract

BACKGROUND

Surgical stress affects the autonomic nervous system by increasing sympathetic outflow. One method of monitoring sympathetic activity is pulse photoplethysmographic analysis. From this two indices can be derived - autonomic nervous system state (ANSS) and ANSS index (ANSSi). It has recently been claimed that these indices can be used to measure sympathetic activity in anaesthetised patients, but their validity has not yet been demonstrated.

OBJECTIVE

To measure changes in pulse photoplethysmographic indices and determine any agreement with autonomic nervous system modulation of the cardiovascular system in healthy study participants during surgery under general anaesthesia.

DESIGN

Prospective observational study.

SETTING

Single-centre study based at a tertiary care centre in Milan, Italy.

PATIENTS

Healthy patients undergoing general anaesthesia for elective laparoscopic cholecystectomy.

INTERVENTIONS

ANSS, ANSSi, and heart rate variability (HRV) were analysed at three main times: baseline, after induction of general anaesthesia, and after pneumoperitoneum insufflation.

MAIN OUTCOME MEASURES

The magnitude of changes in photoplethysmographic and HRV indices was measured. The agreement between pulse photoplethysmographic and HRV-derived indices was assessed by Bland-Altman plots.

RESULTS

In total, 52 patients were enrolled and their data analysed. Both pulse photoplethysmographic and HRV indices changed during the study phases. An agreement was found between ANSSi and low frequency spectral components of HRV [bias 10.2nu, 95% confidence interval (CI) -13 to 33.4], high frequency spectral components of HRV (bias 6.1 nu, 95% CI -16.3 to 28.6), and low frequency/high frequency ratio (bias 16.1nu, 95% CI -1.4 to 33.5). The agreement was weaker between ANSSI and HRV indices.

CONCLUSION

The study endorses the use of pulse photoplethysmographic indices ANSS and ANSSi as surrogates to estimate changes of autonomic modulation of the cardiovascular system in healthy adults during surgery under general anaesthesia.Orcid ID: orcid.org/0000-0002-9616-803X.

摘要

背景

手术应激通过增加交感神经输出而影响自主神经系统。监测交感神经活动的一种方法是脉搏光体积描记分析。由此可以得出两个指标 - 自主神经系统状态（ANSS）和自主神经系统指数（ANSSi）。最近有人声称，这些指标可用于测量麻醉患者的交感神经活动，但尚未证明其有效性。

目的

测量麻醉患者手术期间脉搏光体积描记指数的变化，并确定其与心血管系统自主神经调节的一致性。

设计

前瞻性观察性研究。

地点

意大利米兰的一个三级护理中心的单中心研究。

患者

接受全身麻醉择期腹腔镜胆囊切除术的健康患者。

干预措施

在三个主要时间点分析 ANSS、ANSSi 和心率变异性（HRV）：基线、全身麻醉诱导后和人工气腹充气后。

主要观察指标

测量光体积描记和 HRV 指数变化的幅度。通过 Bland-Altman 图评估脉搏光体积描记和 HRV 衍生指数之间的一致性。

结果

共纳入 52 例患者并分析其数据。在研究阶段，光体积描记和 HRV 指数均发生变化。在 ANSSi 与 HRV 的低频谱分量[偏差 10.2nu，95%置信区间（CI）-13 至 33.4]、高频谱分量（偏差 6.1nu，95%CI-16.3 至 28.6）和低频/高频比值（偏差 16.1nu，95%CI-1.4 至 33.5）之间发现了一致性。ANSSi 与 HRV 指数之间的一致性较弱。