三种痛觉指数预测全麻苏醒前术后即刻疼痛的有效性：一项前瞻性、双盲、观察性研究

本文由“罂粟花”授权转载

三种痛觉指数预测全麻苏醒前术后即刻疼痛的有效性：一项前瞻性、双盲、观察性研究  

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：伤害性监测设备旨在评估全身麻醉期间的伤害性感受。我们评估了心率和三种伤害性指数预测全身麻醉苏醒前术后疼痛的准确性。  

方法：创伤或骨科手术患者于手术结束后苏醒前5min同时记录HR、手术Pleth指数(SPI)、瞳孔疼痛指数(PPI)和伤害性水平(NOL)。入院后2h定期评估疼痛评分。采用受试者工作特征曲线下面积(AUC)、Spearman等级相关系数和回归模型分析HR、SPI、PPI和NOL对术后疼痛和阿片类药物用量的预测准确性。  

结果：对60名受试者的数据进行了分析。不同疼痛指数预测中重度疼痛准确性的AUC值(95%可信区间[95%CI])不同(HR=0.46[0.29-0.64]，P=0.671；SPI=0.46[0.31-0.61]，P=0.621；PPI=0.52[0.36-0.68]，P=0.770；NOL=0.66[0.51-0.81]，P=0.038)。在多变量Logistic回归模型中，将NOL值与ASA评分和区域麻醉使用情况相结合的多变量预测因子具有更高的预测准确性(AUC=0.83[0.72-0.94]，P<0.001)。  

结论：在全身麻醉苏醒前测量的心率、手术Pleth指数、瞳孔疼痛指数和伤害性水平尚不足以预测术后疼痛的诊断准确性。  

原始文献来源：Kim C. Koschmieder, Sandra Funcke, Mahshid Shadloo, et al. Validation of three nociception indices to predict immediate postoperative pain before emergence from general anaesthesia: a prospective double-blind, observational study.[J]Br J Anae, doi: 10.1016/j.bja.2022.11.024.    

英文原文：

Validation of three nociception indices to predict immediate postoperative pain before emergence from general anaesthesia: a prospective double-blind, observational study

Abstract  

Background: Nociception monitoring devices are designed to estimate nociception during general anaesthesia. We evaluated the predictive accuracy of heart rate and three nociception indices to predict postoperative pain before emergence from general anaesthesia.  

Method: In patients undergoing trauma or orthopaedic surgery, HR, Surgical Pleth Index® (SPI), Pupillary Pain Index® (PPI), and Nociception Level® (NOL) were simultaneously recorded for 5 min after the end of surgery but before return of consciousness. After admission to the recovery room, pain scores were assessed regularly for 2 h. HR, SPI, PPI, and NOL were analysed for their predictive accuracy of postoperative pain and opioid consumption with assessment of area under the receiver operating characteristic (AUC) curves, Spearman rank-correlation coefficient, and regression modelling.  

Results: Data for 60 subjects were analysed. The AUC (95% confidence interval [95% CI]) of the predictive accuracy for moderate-to-severe postoperative pain differed between nociception indices (HR=0.46 [0.29-0.64], P=0.671; SPI=0.46 [0.31-0.61], P=0.621; PPI=0.52 [0.36-0.68], P=0.770; NOL=0.66 [0.51-0.81], P=0.038). In a multivariable logistic regression model, a higher predictive accuracy was found for a multivariable predictor combining NOL values with ASA physical status and information about use of regional anaesthesia (AUC=0.83 [0.72-0.94], P<0.001).  

Conclusion: Heart rate, Surgical Pleth Index, Pupillary Pain Index, and Nociception Level measured before emergence from general anaesthesia do not yet have sufficient diagnostic accuracy for prediction of postoperative pain.  

免责声明：

本微信公众平台所刊载原创或转载内容不代表米勒之声的观点或立场。文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

—END—

编辑：MiSuper.米超

校对：Michel.米萱

打赏