手术体积描记指数监测全凭静脉麻醉患者伤害性刺激的应用研究

刘华为; 陈凤; 丁锦屏; 陈勤; 左都坤; 任玉坤; 彭滔滔; 段振馨; 李洪

doi:10.16016/j.2097-0927.202205088

您当前的位置：

首页 >

文章列表页 >

手术体积描记指数监测全凭静脉麻醉患者伤害性刺激的应用研究

临床医学 | 更新时间：2026-01-09

- 手术体积描记指数监测全凭静脉麻醉患者伤害性刺激的应用研究
- Application of surgical pleth index in monitoring nociceptive stimulation in patients with total intravenous anesthesia
- 陆军军医大学学报 2022年44卷第17期页码：1757-1763
- 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：
  
  [李洪，E-mail: lh78553@163.comLI Hong, E-mail: lh78553@163.com
- 基金信息：
  
  国家重点研发计划(2018YFC0117200)
- DOI：10.16016/j.2097-0927.202205088
  中图分类号： R181.32;R444;R614.24
- 收稿：2022-05-16，
  
  修回：2022-06-24，
  
  纸质出版：2022-09-15
- 稿件说明：
移动端阅览
刘华为, 陈凤, 丁锦屏, 等. 手术体积描记指数监测全凭静脉麻醉患者伤害性刺激的应用研究[J]. 陆军军医大学学报, 2022,44(17):1757-1763.

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.
刘华为, 陈凤, 丁锦屏, 等. 手术体积描记指数监测全凭静脉麻醉患者伤害性刺激的应用研究[J]. 陆军军医大学学报, 2022,44(17):1757-1763. DOI： 10.16016/j.2097-0927.202205088.

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

VON D F. Monitoring of pain, nociception, and analgesia under general anesthesia: Relevance, current scientific status, and clinical practice[J]. Anaesthesist, 2015, 64(10): 758-764. DOI: 10.1007/s00101-015-0080-0.

FUNCKE S, SAUERLAENDER S, PINNSCHMIDT H O, et al . Validation of innovative techniques for monitoring nociception during general anesthesia: a clinical study using tetanic and intracutaneous electrical st imulation[J ] . Anesthesiology, 2017, 127(2): 272-283. DOI: 10.1097/ALN.0000000000001670.

陈莹, 王品莹, 王俊. 手术体积描计指数在腹腔镜手术中镇痛深度监测的应用[J]. 临床麻醉学杂志, 2017, 33(12): 1220-1221.

CHEN Y, WANG P Y, WANG J. Application of surgical plethysmography index in monitoring the depth of analgesia in laparoscopic surgery[J]. J Clin Anesthesiol, 2017, 33(12): 1220-1221.

MUSTOLA S, PARKKARI T, UUTELA K, et al . Performance of surgical stress index during sevoflurane-fentanyl and isoflurane-fentanyl anesthesia[J ] . Anesthesiol Res Pract, 2010, 2010: 810721. DOI: 10.1155/2010/810721.

LEDOWSKI T, SCHNEIDER M, GRUENEWALD M, et al . Surgical pleth index: prospective validation of the score to predict moderate-to-severe postoperative pain[J ] . Br J Anaesth, 2019, 123(2): e328-e332. DOI: 10.1016/j.bja.2018.10.066.

BERGMANN I, GÖHNER A, CROZIER T A, et al . Surgical pleth index-guided remifentanil administration reduces remifentanil and propofol consumption and shortens recovery times in outpatient anaesthesia[J ] . Br J Anaesth, 2013, 110(4): 622-628. DOI: 10.1093/bja/aes426.

DOSTALOVA V, SCHREIBEROVA J, BARTOS M, et al . Surgical pleth index and analgesia nociception index for intraoperative analgesia in patients undergoing neurosurgical spinal procedures: a comparative randomized study[J ] . Minerva Anestesiol, 2019, 85(12): 1265-1272. DOI: 10.23736/S0375-9393.19.13765-0.

FUNCKE S, PINNSCHMIDT H O, WESSELER S, et al . Guiding opioid administration by 3 different analgesia nociception monitoring indices during general anesthesia alters intraoperative sufentanil consumption and stress hormone release: a randomized controlled pilot study[J ] . Anesth Analg, 2020, 130(5): 1264-1273. DOI: 10.1213/ANE.0000000000004388.

NIMMO A F, ABSALOM A R, BAGSHAW O, et al . Guidelines for the safe practice of total intravenous anaesthesia (TIVA): joint Guidelines from the Association of Anaesthetists and the Society for Intravenous Anaesthesia[J ] . Anaesthesia, 2019, 74(2): 211-224. DOI: 10.1111/anae.14428.

SHOAR S, NADERAN M, EBRAHIMPOUR H, et al . A prospective double-blinded randomized controlled trial comparing systemic stress response in Laparoascopic cholecystectomy between low-pressure and standard-pressure pneumoperitoneum[J ] . Int J Surg, 2016, 28((1)): 28-33. DOI: 10.1016/j.ijsu.2016.02.043.

SIDIROPOU LOU I, TSAOUSI G G, POURZITAKI C, et al . Impact of anesthetic technique on the stress response elicited by laparoscopic cholecystectomy: a randomized trial[J ] . J Anesth, 2016, 30(3): 522-525. DOI: 10.1007/s00540-016-2148-7.

LEE J H, CHOI B M, JUNG Y R, et al . Evaluation of Surgical Pleth Index and Analgesia Nociception Index as surrogate pain measures in conscious postoperative patients: an observational study[J ] . J Clin Monit Comput, 2020, 34(5): 1087-1093. DOI: 10.1007/s10877-019-00399-5.

KIM J H, JWA E K, CHOUNG Y, et al . Comparison of pupillometry with surgical pleth index monitoring on perioperative opioid consumption and nociception during propofol-remifentanil anesthesia: a prospective randomized controlled trial[J ] . Anesth Analg, 2020, 131(5): 1589-1598. DOI: 10.1213/ANE.0000000000004958.

HARJU J, KALLIOMÄKI M L, LEPPIKANGAS H, et al . Surgical pleth index in children younger than 24 months of age: a randomized double-blinded trial[J ] . Br J Anaesth, 2016, 117(3): 358-364. DOI: 10.1093/bja/aew215.

ILIES C, LUDWIGS J, GRUENEWALD M, et al . The effect of posture and anaesthetic technique on the surgical pleth index[J ] . Anaesthesia, 2012, 67(5): 508-513. DOI: 10.1111/j.1365-2044.2011.07051.x.

HANS P, VERSCHEURE S, UUTELA K, et al . Effect of a fluid challenge on the Surgical Pleth Index during stable propofol-remifentanil anaesthesia[J ] . Acta Anaesthesiol Scand, 2012, 56(6): 787-796. DOI: 10.1111/j.1399-6576.2011.02639.x.

HÖCKER J, BROCH O, GRÄSNER J T, et al . Surgical stress index in response to pacemaker stimulation or atropine[J ] . Br J Anaesth, 2010, 105(2): 150-154. DOI: 10.1093/bja/aeq114.

ILIES C, GRUENEWALD M, LUDWIGS J, et al . Evaluation of the surgical stress index during spinal and general anaesthesia[J ] . Br J Anaesth, 2010, 105(4): 533-537. DOI: 10.1093/bja/aeq203.

MUSTOLA S, TOIVONEN J. Effect-site concentration of remifentanil attenuating surgical stress index responses to intubation of the Trachea[J]. Anaesthesia, 2010, 65(6): 581-585. DOI: 10.1111/j.1365-2044.2010.06329.x.

郭玉平, 张立维, 苗阔, 等. 成人甲状腺结构及碘营养状况与性别和年龄的相关性研究[J]. 中国超声医学杂志, 2020, 36(7): 588-591. DOI: 10.3969/j.issn.1002-0101.2020.07.005.

GUO Y P, ZHANG L W, MIAO K, et al . Correlation of thyroid structure and iodine nutrition st atus with sex and age in adults[J ] . Chin J Ultrasound Med, 2020, 36(7): 588-591. DOI:10.3969/j.issn.1002-0101.2020.07.005.

CHEN X Z, THEE C, GRUENEWALD M, et al . Correlation of surgical pleth index with stress hormones during propofol-remifentanil anaesthesia[J ] . Sci World J, 2012, 2012: 879158. DOI:10.1100/2012/879158.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

暂无数据