医生手控与计算机闭环系统控制调节去氧肾上腺素维持猪模型血压
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Physician-Directed Versus Computerized Closed-Loop Control of Blood Pressure Using Phenylephrine in a Swine Model
背景与目的
升压药提供了一种快速有效的方法来纠正围手术期低血压。本课题组研制了一种闭环控制（CLC）系统，它可以根据全麻期间平均动脉压（MAP）来调控滴定去氧肾上腺素（PHP）。作为评估系统能力的一种方法，我们比较了临床医生与CLC对血压的管理以确定其性能。我们假设CLC算法更有效地维持血压在指定目标，血压变异性较小，并减少PHP的所需剂量。
方 法
采用交叉研究设计，给6只猪进行全身麻醉。使用硝普钠控制性降压。医生（MD）手动调节PHP的注入速率，CLC系统自动调控PHP的注入速率，每3秒调整一次以达到预定的MAP。
结 果
CLC维持MAP在目标的5mmHg以内（平均值±标准差），时间93.5%±3.9%而MD调节时间为72.4%±26.8%（P＝0.054）。CLC和MD干预措施的平均时间百分比分别超过目标范围2.1%±3.3%和25.8%±27.4%（p＝0.06）。CLC与MD干预的控制统计，性能误差，中位数性能误差，中位数绝对性能误差无差异。 在60分钟的个人研究中医生调整PHP输液速率次数达12到80次。 2个干预措施中使用的PHP的总剂量无差异。
结 论
通过调节PHP控制MAP，CLC系统调控与麻醉师手动调控一样有效。计算机化的CLC输注PHP能在实验性血管舒张的条件下提供更小的血压变化。
原始文献摘要
Nicole Ribeiro Marques, MD, William E. Whitehead, PhD, Upendar R. Kallu, PhD,Michael P. Kinsky, MD,Joe S. Physician-Directed Versus Computerized Closed-Loop Control of Blood Pressure Using Phenylephrine in a Swine Model. Anesth Analg 2017.7
BACKGROUND:Vasopressors provide a rapid and effective approach to correct hypotension in the perioperative setting. Our group developed a closed-loop control (CLC) system that titrates phenylephrine (PHP) based on the mean arterial pressure (MAP) during general anesthesia. As a means of evaluating system competence, we compared the performance of the automated CLC with physicians. We hypothesized that our CLC algorithm more effectively maintains blood pressure at a specified target with less blood pressure variability and reduces the dose of PHP required.
METHODS: In a crossover study design, 6 swine under general anesthesia were subjected to a normovolemic hypotensive challenge induced by sodium nitroprusside. The physicians (MD) manually changed the PHP infusion rate, and the CLC system performed this task autonomously, adjusted every 3 seconds to achieve a predetermined MAP.
RESULTS: The CLC maintained MAP within 5 mm Hg of the target for (mean ± standard deviation) 93.5% ± 3.9% of the time versus 72.4% ± 26.8% for the MD treatment (P = .054). The mean (standard deviation) percentage of time that the CLC and MD interventions were above target range was 2.1% ± 3.3% and 25.8% ± 27.4% (P = .06), respectively. Control statistics, performance error, median performance error, and median absolute performance error were not different between CLC and MD interventions. PHP infusion rate adjustments by the physician were performed 12 to 80 times in individual studies over a 60-minute period. The total dose of PHP used was not different between the 2 interventions.
CONCLUSIONS: The CLC system performed as well as an anesthesiologist totally focused on MAP control by infusing PHP. Computerized CLC infusion of PHP provided tight blood pressure control under conditions of experimental vasodilation.
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