全凭静脉麻醉下镇痛-伤害性刺激指数对于腹腔镜手术疼痛刺激评估的有效性

摘要

目的 观察气管插管后, 腹腔镜手术戳卡置入时, 伤害性刺激指数 (ANI) 与血流动力学变化的相关性, 从而评估ANI的有效性.方法 本研究为多中心、前瞻临床研究.选取行腹腔镜手术患者284例, 患者入室后, 完善监护, 应用靶控瑞芬太尼和丙泊酚进行麻醉诱导完成气管插管, 完善动脉穿刺, 后采取丙泊酚和瑞芬太尼靶控麻醉维持.记录入室、第一个戳卡完成时及戳卡完成后5 min的ANI数值、动脉收缩压、心率值 (研究过程采用电子数据连续记录所需数值) .观察在腹腔镜手术过程中从入室到所有戳卡置入完成后5 min的ANI数值及收缩压 (SBP) 及心率 (HR) 变化情况, 从而评估ANI指数评估腹腔镜戳卡置入时引起的疼痛的有效性.结果 (1) 在切皮-完成所有戳卡后5min的研究时间段内, ANI曲线下面积与SBP、HR曲线下面积呈现正相关性 (P <0.05) . (2) 在切皮-第一个戳卡置入完成时, ANI与SBP、HR呈负相关性 (P <0.001) .结论 ANI的变化与镇痛与伤害性刺激之间平衡关系的变化相一致, 与SBP、HR的变化呈负性相关, ANI可以准确的评估戳卡置入时疼痛的情况.%Objective To observe the correlation between analgesia nociception index (ANI) and hemodynamic changes during laparoscopic surgery after tracheal intubation andto assess the effectiveness of ANI.Methods A multicenter, prospective clinical study was conducted and 284 patients underwent laparoscopic surgery were enrolled. Patients were monitored after entering the operating room. Endotracheal intubation was completed by anesthesia induction with target controlled remifentanil and propofol, after arterial and central venous catheterization were improved. Anesthesia was maintainedby continued propofol and remifentanil target controlled infusion.The ANI value, systolic pressure, heart rate of 5 minutes after completion of the entry, completion of the first trocar and completion of all the trocars were recorded. The ANI values and the changes in the vital signs (systolicblood pressure and heart rate) were observed during the laparoscopic operation, and the effectiveness of the ANI index to assess the pain caused by the insertion of a laparoscope trocar was evaluated. Results (1) The area under the ANI curve was positively correlated with the one under thesystolic blood pressure and the heart rate curve during the period from cutting the skin to 5 mins after completing all the trocars (P < 0.05). (2) ANI was negatively correlated with SBP and HR when skin incision and the first trocar were completed (P < 0.001). Conclusions The changes in ANI were in accordance with the balance between analgesic and noxious stimuli, and negatively correlated with the changes insystolic blood pressure and heart rate. ANI could accurately evaluate the pain situation when the card was inserted.