Application of surgical pleth index in monitoring nociceptive stimulation in patients with total intravenous anesthesia

Huawei LIU; Feng CHEN; Jinping DING; Qin CHEN; Dukun ZUO; Yukun REN; Taotao PENG; Zhenxin DUAN; Hong LI

doi:10.16016/j.2097-0927.202205088

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Application of surgical pleth index in monitoring nociceptive stimulation in patients with total intravenous anesthesia

Clinical Medicine | 更新时间：2026-01-09

- Application of surgical pleth index in monitoring nociceptive stimulation in patients with total intravenous anesthesia
- Journal of Army Medical University Vol. 44, Issue 17, Pages: 1757-1763(2022)
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院麻醉科
- 作者简介：
- 基金信息：
  
  the National Key Research and Development Program(2018YFC0117200)
- DOI：10.16016/j.2097-0927.202205088
  CLC： R181.32;R444;R614.24
- Received：16 May 2022，
  
  Revised：2022-06-24，
  
  Published：15 September 2022
- 稿件说明：
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Huawei LIU, Feng CHEN, Jinping DING, et al. Application of surgical pleth index in monitoring nociceptive stimulation in patients with total intravenous anesthesia[J]. Journal of Army Medical University, 2022, 44(17): 1757-1763.
DOI：

Huawei LIU, Feng CHEN, Jinping DING, et al. Application of surgical pleth index in monitoring nociceptive stimulation in patients with total intravenous anesthesia[J]. Journal of Army Medical University, 2022, 44(17): 1757-1763. DOI： 10.16016/j.2097-0927.202205088.

摘要

目的

探讨手术体积描记指数(surgical pleth index，SPI)监测全凭静脉麻醉患者伤害性刺激的准确性以及对伤害性刺激心血管反应的预测性。

方法

择期甲状腺手术患者102例，年龄18~65岁，ASAⅠ~Ⅱ级，BMI 18.5~30 kg/m

。每例患者均采用静脉麻醉诱导，靶控输注丙泊酚和瑞芬太尼麻醉维持，采用SPI行镇痛深度监测。记录患者伤害性刺激前2 min和伤害性刺激时SPI、心率(HR)、平均动脉压(MAP)的绝对值以及伤害性刺激后2 min内SPI、HR、MAP的最大值。采用受试者操作特征(receiver operating characteristic，ROC)曲线对SPI、HR、MAP监测伤害性刺激的准确性以及SPI对伤害性刺激心血管反应的预测性进行分析。

结果

根据ROC曲线分析，在监测气管插管刺激准确性方面，SPI[曲线下面积(area under roc curve，AUC)=0.931，最佳截断值=30

]

优于HR(AUC=0.804，最佳截断值=68)、MAP(AUC=0.759，最佳截断值=80)，ΔSPI(AUC=0.990，最佳截断值=4)优于ΔHR(AUC=0.972，最佳截断值=3)、ΔMAP(AUC=0.854，最佳截断值=3)，ΔSPI优于SPI，ΔHR优于HR，ΔMAP优于MAP，以上AUC差异均具有统计学意义(

0.05)；在监测切皮刺激准确性方面，SPI(AUC=0.925，最佳截断值=43)优于HR(AUC=0.587，最佳截断值=65)、MAP(AUC=0.804，最佳截断值=76)，ΔSPI(AUC=0.998，最佳截断值=7)优于ΔHR(AUC=0.833，最佳截断值=1)、ΔMAP(AUC=0.943，最佳截断值=3)，ΔSPI优于SPI，ΔHR优于HR，ΔMAP优于MAP，以上AUC差异均具有统计学意义(

0.05)；SPI对气管插管刺激心血管反应具有预测意义(AUC=0.662，最佳截断值=17，

0.05)，但对切皮刺激心血管反应不具有预测意义(

0.05)。

结论

SPI绝对值与变化差值在监测伤害性刺激准确性方面均较优于传统的血流动力学指标HR、MAP，能对术中伤害性刺激进行更准确地监测；SPI对气管插管刺激心血管反应具有预测价值，对判断合适的插管时机具有重要的临床意义。

Abstract

Objective

To investigate the accuracy of surgical pleth index (SPI) in monitoring patients with nociceptive stimulation and its predictability for cardiovascular response to nociceptive stimulation in total intravenous anesthesia (TIVA).

Methods

A total of 102 patients (aged 18 to 65 years

ASAⅠtoⅡ

and BMI of 18.5 to 30 kg/㎡) who underwent elective thyroid surgery in our hospital from February to June 2022 were enrolled in this study. Each patient was induced by intravenous anesthesia

maintained by target-controlled infusion of propofol and remifentanil

and monitored by SPI for analgesia depth. The absolute values of SPI

heart rate (HR) and mean arterical pressure (MAP) of patients 2 min before and during nociceptive stimulation and the maximum values of SPI

HR and MAP within 2 min after nociceptive stimulation were recorded. Receiver operating characteristic (ROC) curve was used to analyze the accuracy of SPI

HR and MAP in monitoring nociceptive stimulation and the predictability of SPI in cardiovascular response to nociceptive stimulation.

Results

ROC curve analysis indicated that SPI (AUC=0.931

Cutoff value=30) was superior to HR (AUC=0.804

Cutoff value=68) and MAP (AUC=0.759

Cutoff value=80) in monitoring accuracy of tracheal intubation stimulation

ΔSPI (AUC=0.990

Cutoff value=4) was better than ΔHR (AUC=0.972

Cutoff value=3) and ΔMAP (AUC=0.854

Cutoff value=3)

ΔSPI was better than SPI

ΔHR was better than HR

and ΔMAP was better than MAP

with their AUC values statistically different (

0.05). In terms of monitoring the accuracy of skin incisions

SPI (AUC=0.925

Cutoff value=43) was superior to HR (AUC=0.587

Cutoff value=65) and MAP (AUC=0.804

Cutoff value=76)

ΔSPI (AUC=0.998

Cutoff value=7) was better than ΔHR (AUC=0.833

Cutoff value=1) and ΔMAP (AUC=0.943

Cutoff value=3)

ΔSPI was better than SPI

ΔHR was better than HR

and ΔMAP was better than MAP

and the above AUC differences were statistically significant (

0.05); SPI had predictive value for the cardiovascular response stimulated by tracheal intubation (AUC=0.662

Cutoff value=17

0.05)

but had no predictive significance for the cardiovascular response stimulated by skin incisions (

0.05).

Conclusion

The absolute value and change of SPI are better than the traditional hemodynamic indexes HR and MAP in monitoring the accuracy of nociceptive stimulation

which can accurately monitor nociceptive stimulation during operation. SPI has predictive value for the cardiovascular response stimulated by intubation stimulation

and has important clinical significance for judging the appropriate timing of intubation.

关键词

Keywords

references

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