基于光电容积指脉搏波预测择期剖宫产腰麻后低血压的研究
发布时间：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,是剖宫产麻醉中最常用的区域阻滞麻醉技术。低血压(hypotension)是腰麻的最常见并发症,其机制主要是交感神经节前纤维阻滞后系统血管阻力的下降以及血液积聚于躯体阻滞部位引起的心输出量的减少。妊娠使交感神经张力增高,妊娠子宫对下腔静脉的压迫使回心血量进一步减少,故而孕妇更易发生腰麻后低血压。腰麻后低血压对母婴均具有潜在的不良影响。年龄,体重指数(BMI),交感神经基础张力,外周血管阻力等均可影响腰麻后低血压的程度。 光电容积脉搏波(photoplethysmographic pulse wave, PPGPW)是根据外周微血管的血液容积随心脏搏动而产生的脉动性变化,通过光电容积描记法(photolethtysmography, PPG)获得的周期性的波形,包含血流动力学、心搏功能、微循环病理生理、植物神经功能等诸多生理信息。因此,我们推定光电容积脉搏波特征参数或许可以用来预测剖宫产腰麻后低血压风险。 目的： 通过分析光电容积脉搏波特征参数与发生腰麻后低血压之间的相关性,建立剖宫产腰麻后低血压风险的预测模型,用于指导临床低血压的预防。 方法： 选择择期行剖宫产的20-40岁足月健康孕妇(ASA1-2级)69例。所有病人麻醉前均给予快速静脉输注500ml羟乙基淀粉130/0.4(万汶)。采用左侧卧位,与L3-4或L4-5间隙穿刺人蛛网膜下腔,注入重比重罗哌卡因15mg。控制阻滞平面在T4-5。记录病人的一般情况,血流动力学数据,胎儿情况,通过计算机实时连续记录光电容积指脉搏波波形并且提取手术前一天(DBS),手术当天预扩容前(DOS-BP),手术当天预扩容后至麻醉前(DOS-AP),麻醉后一分钟(SBA+1)的波形特征参数,通过多因素logic回归分别建立预测模型,选取最佳模型,并通过ROC曲线选取阈值,计算敏感性和特异性。 结果： 手术前一天(DBS)基于光电容积脉搏波特征参数建立的预测模型预测效果最好,AUC为0.8259,其95%CI为0.7285-0.9232,预测效果良好。预测模型表现式为log it(π)=8.8076+0.2363AGE-0.3819BMI-0.2539PPGA-0.4723ARD+0.3940ART,当以概率0.61为阈值时,敏感度为72.50%,特异性为72.41%。 结论： 基于术前一天光电容积脉搏波特征参数建立的预测模型可以较好的预测择期剖宫产腰麻后低血压的风险。
[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.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
本文编号：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.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
【参考文献】
相关期刊论文 前1条
1 杨琳;张松;杨益民;罗志昌;;基于重搏波谷点的脉搏波波形特征量分析[J];北京生物医学工程;2008年03期
，本文编号：2425955
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