使用手术体积描计指数引导瑞芬太尼用药对老年患者围术期预后的影响:一项前瞻性随机对照试验

使用手术体积描计指数引导瑞芬太尼用药对老年患者围术期预后的影响:一项前瞻性随机对照试验

贵州医科大学   麻醉与心脏电生理课题组

翻译:张中伟   编辑：张中伟   审校：曹莹

背景：在全身麻醉期间，手术体积描计指数（SPI)可用于术中痛觉监测。老年人SPI方面相关的研究仍然很少。我们的目的是根据手术体积描计指数（SPI)与血流动力学参数(心率或血压)来研究术中应用阿片类药物是否会对老年患者的围手术期结果产生影响。

方法: 将65~90岁在七氟烷/瑞芬太尼麻醉下行腹腔镜结直肠癌手术的患者随机分为SPI引导下瑞芬太尼组(SPI组)和根据血流动力学参数进行常规临床判断的常规组(常规组)。主要观察指标是术中瑞芬太尼的用量。次要观察指标是术中血流动力学不稳定的发生、疼痛评分、芬太尼用量和麻醉后监护病房(PACU)的谵妄发生率，以及围手术期白介素-6（IL-6）和自然杀伤(NK)细胞活性的变化。

结果：75名患者(38名SPI；37名普通患者)被纳入本研究。SPI组术中瑞芬太尼用量明显多于常规组(P<0.001)，瑞芬太尼用量分别为(0.13±0.05)和(0.06±0.04)μg/kg/min。术中高血压和心动过速在常规组比SPI组更常见(P=0.013)。SPI组PACU疼痛评分和PACU谵妄发生率(5.2%)明显低于常规组(P=0.0 2)。两组患者NK细胞活性和IL-6水平无明显差异。

结论：在老年患者中，SPI引导下的瑞芬太尼用量充足，高血压/心动过速事件发生率较低，PACU精神障碍发生率较传统镇痛组低。然而，SPI引导的镇痛并不能逆转围手术期免疫系统的恶化。

原始文献来源：Young Ju Won, Seok Kyeong Oh, Byung Gun Lim，et al.Effect of surgical pleth index-guided remifentanil administration on perioperative outcomes in elderly patients: a prospective randomized controlled triall.[J]. BMC Anesthesiology (2023) 23:57

英文原文：

Effect of surgical pleth index-guided remifentanil administration on perioperative outcomes in elderly patients: a prospective randomized controlled trial

Abstract Background During general anesthesia, the surgical pleth index (SPI) monitors nociception. The evidence of SPI in the elderly remains scarce. We aimed to investigate whether there is a difference in perioperative outcomes following intraoperative opioid administration according to the surgical pleth index (SPI) value versus hemodynamic parameters (heart rate or blood pressure) in elderly patients.

Methods Patients aged 65–90 years who underwent laparoscopic colorectal cancer surgery under sevoflurane/ remifentanil anesthesia were randomized to receive remifentanil guided by SPI (SPI group) or conventional clinical judgment based on hemodynamic parameters (conventional group). The primary endpoint was intraoperative remifentanil consumption. Secondary endpoints were intraoperative hemodynamic instability, pain score, fentanyl consumption and delirium in the post-anesthesia care unit (PACU), and perioperative changes in interleukin-6 and natural killer (NK) cell activity.

Results Seventy-five patients (38, SPI; 37, conventional) were included in the study. The SPI group consumed significantly more remifentanil intraoperatively than the conventional group (mean ± SD, 0.13 ± 0.05 vs. 0.06 ± 0.04 μg/kg/ min, P < 0.001). Intraoperative hypertension and tachycardia were more common in the conventional group than in the SPI group. Pain score in the PACU (P = 0.013) and the incidence of delirium in the PACU were significantly lower in the SPI group than the conventional group (5.2% vs. 24.3%, P = 0.02). There was no significant difference in NK cell activity and interleukin-6 level.

Conclusions In the elderly patients, SPI-guided analgesia provided appropriate analgesia with sufficient intraoperative remifentanil consumption, lower incidence of hypertension/ tachycardia events, and a lower incidence of delirium in the PACU than the conventional analgesia. However, SPI-guided analgesia may not prevent perioperative immune system deterioration.

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