【罂粟摘要】基于脑电分析的危重病患者对伤害性刺激反应性预测与检测：一项单中心的回顾性分析

基于脑电分析的危重病患者对伤害性刺激反应性预测与检测：一项单中心的回顾性分析  

贵州医科大学麻醉与心脏电生理课题组

翻译：佟睿     

编辑：柏雪    审校：曹莹

背景：对无法自主诉说的危重病人来说，疼痛和痛觉监测仍然是一个挑战，因为临床症状既不敏感也不特异。现有的技术方法受到了各种限制。我们研究了基于脑电图（EEG）寻找在有害刺激之前或与行为痛觉反应相吻合的相关因素。

方法：在这项回顾性研究中，我们分析了64名危重病人在吸痰前、吸痰时和吸痰后的额叶脑电图记录。我们研究了脑电功率带在行为反应之前或与之一致的相关性(行为疼痛评分7)。我们应用ManneWhitney U检验来计算相应的P值。

结果：在强烈的行为反应之前，2.5-5赫兹频段的归一化功率较高(17.1%；P<0.001)，0.1-1.5赫兹频段的归一化功率较低(-10.5%；P=0.029)。干预后，强烈的行为反应与2.5-5赫兹频段较高的归一化脑电功率(16.6%；P=0.021)和较低的8-12赫兹频段的归一化脑电功率(-51.2%；P=0.037)相关。

结论：我们观察到脑电频段功率的相关性先于伤害性刺激的行为反应，并与之一致。根据以前的发现，一些功率带可能与痛觉、唤醒或镇静效应的处理有关。与伤害性感觉和觉醒更密切相关的功率带可用于改善对伤害性感觉的监测，并优化重症监护患者的镇痛管理。

原始文献来源：Viktor Bublitz, Carlo Jurth, Matthias Kreuzer, et al. Electroencephalogram-based prediction and detection of responsiveness to noxious stimulation in critical care patients: a retrospective single-centre analysis.[J]Br J Anae, doi: 10.1016/j.bja.2022.09.031. 

英文原文：

Electroencephalogram-based prediction and detection of responsiveness to noxious stimulation in critical care patients: a retrospective single-centre analysis

Abstract

Background: Monitoring of pain and nociception in critical care patients unable to self-report pain remains a challenge, as clinical signs are neither sensitive nor specific. Available technical approaches are limited by various constraints. We investigated the electroencephalogram (EEG) for correlates that precede or coincide with behavioural nociceptive responses to noxious stimulation

Method: In this retrospective study, we analysed frontal EEG recordings of 64 critical care patients who were tracheally intubated and ventilated before, during, and after tracheal suctioning. We investigated EEG power bands for correlates preceding or coinciding with behavioural responses (Behavioural Pain Scale 7). We applied the ManneWhitney U-test to calculate corresponding P-values.

Results: Strong behavioural responses were preceded by higher normalised power in the 2.5e5 Hz band (+17.1%; P<0.001) and lower normalised power in the 0.1-1.5 Hz band (-10.5%; P=0.029). After the intervention, strong behavioural responses were associated with higher normalised EEG power in the 2.5-5 Hz band (+16.6%; P=0.021) and lower normalised power in the 8-12 Hz band (-51.2%; P=0.037)

Conclusion: We observed correlates in EEG band power that precede and coincide with behavioural responses to noxious stimulation. Based on previous findings, some of the power bands could be linked to processing of nociception, arousal, or sedation effects. The power bands more closely related to nociception and arousal could be used to improve monitoring of nociception and to optimise analgesic management in critical care patients

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