灌流指標在麻醉臨床的應用

Clinical Application of Perfusion Index in Anesthetic Practice

朱俊霖(Chun-Lin Chu)

指導教授 ： 黃義侑

國立臺灣大學/工學院/醫學工程學研究所/博士(2018年)

https://doi.org/10.6342/NTU201804138

摘要

灌流指標(Perfusion index, PI)是使用紅外線經過手指並接收後量測局部組織吸收的狀況，進而反應局部血液灌流狀態。由於其方便性與非侵入性，因此適用於多種狀況以得到額外的生理資訊。
灌流指標目前已有相當多的研究證實其臨床的應用價值，包括應用於新生兒的預後判斷及先天性心臟病的預測，及使用於急診或加護病房內判斷病人敗血症或心肺復甦術的預後。灌流指標在圍術期的變化更是麻醉科醫師在麻醉前中後的參考指標。
本篇論文第一部分探討在麻醉中當腎水腫的病人於經輸尿管碎石術重建尿路暢通後灌流指標的變化，藉以證明灌流指標可以顯示手術前後周邊微循環的改變。第二部份則是灌流指標在恢復室的應用，以疼痛刺激交感神經使周邊血管收縮導致灌流指標下降的特性探討病人在恢復室的主觀疼痛分數與客觀灌流指標的相關性，並將病患出恢復室時灌流指標與基礎灌流指標做比較，藉以當作病患出恢復室客觀疼痛評估的條件。

關鍵字

腎水腫 ； 灌流指標 ； 輸尿管碎石術 ； 疼痛分數 ； 恢復室指標

並列摘要

Perfusion index derived from measurement of the strength of return infrared light across the finger is a relative assessment of pulse strength. It is applied widely to acquire additional physiological information because of its non-invasiveness and convenience.
Perfusion index has been approved its value in clinical application by several studies. Perfusion index was used to predict the outcome of new born infant and congenital cardiovascular defect of neonates. It also used in patients with septic shock to predict their mortality rate and the successful probability of cardiopulmonary resuscitation in emergency room. The change of perfusion index during perioperative period is also a valuable reference for anesthesiologist. It helps physicians to early diagnose problem and make correct decision when performing anesthesia.
The first part of this thesis is exploring that increase of perfusion index when re-establishing ureteral patency of hydronephrosis by uretero-renal-scopy with stone manipulation indicates improvement of microcirculation. The second part is the application of perfusion index in postanesthesia care unit (PACU). Pain will activate sympathetic tone and constrict peripheral arteriole, leading to perfusion index decrease. We investigate the relationship between subjective pain score reported by individuals and the objective change of perfusion index. We also use change in PI at the time of discharge from the PACU relative to baseline PI as a supplemental objective discharge criterion for pain assessment.

並列關鍵字

Hydronephrosis ； Perfusion index ； Uretero-renal-scopy (URS) ； visual analogue score (VAS) ； post anesthesia care unit (PACU)

參考文獻

Chapter 1

1. Small, MR (1962). Oliver Wendell Holmes. New York: Twayne Publishers. p. 55. ISBN 978-0-8084-0237-4. OCLC 273508. In a letter to dentist William T. G Mortons. Holmes wrote: "Everybody wants to have a hand in a great discovery. All I will do is to give a hint or two as to names—or the name—to be applied to the state produced and the agent. The state should, I think, be called 'Anaesthesia.' This signifies insensibility—more particularly ... to objects of touch."

2. Hewer CL. The Stages and Signs of General Anaesthesia. Br Med J. 1937;2(3996):274-6. PubMed PMID: 20780832; PubMed Central PMCID: PMCPMC2087073.

3. Standards for Basic Anesthetic Monitoring. Committee of Origin: Standards and Practice Parameters (Approved by the ASA House of Delegates on October 21, 1986, last amended on October 20, 2010, and last affirmed on October 28, 2016) 

4. Joffe R, Duff J, Garcia Guerra G, Pugh J, Joffe AR. The accuracy of blood pressure measured by arterial line and non-invasive cuff in critically ill children. Crit Care. 2016;20(1):177. doi: 10.1186/s13054-016-1354-x. PubMed PMID: 27268414; PubMed Central PMCID: PMCPMC4897864.