镇痛-伤害性刺激指数是一种新的用于吸入全麻手术镇痛水平的临床监测指数  

Analgesia nociception index is a new monitoring index for intraoperative analgesia evaluation in inhalation anesthesia

作　　者：许力[1] 马璐璐[1] 张秀华[1] 黄宇光[1] 

机构地区：[1]中国医学科学院北京协和医院麻醉科,北京100730

出　　处：《基础医学与临床》2014年第7期990-993,共4页Basic and Clinical Medicine

基　　金：中央保健专项基金(B2009B076)

摘　　要：目的观察一种新的临床监测指数:镇痛-伤害性刺激指数(ANI)在吸入全麻下腹腔镜胆囊切除手术中不同疼痛刺激下的变化水平,评估其对临床镇痛水平的指导意义。方法 32例ASAⅠ-Ⅱ级择期行腹腔镜胆囊切除手术患者,七氟醚吸入全麻,通过麻醉/脑电意识监测系统监测NT,使术中麻醉深度维持在D0-D2水平,采用镇痛-伤害性刺激监测仪测定麻醉诱导后无疼痛刺激(T0)、腹腔镜气腹(T1)、腹腔镜穿刺器(trocar)刺入腹腔(T2)、从胆囊床剥离胆囊(T3)、胆囊从腹腔中取出(T4)5个时间点的ANI数值,同时记录各时点血压、心率。结果相同的麻醉深度下,与无疼痛刺激时点T0比较,疼痛刺激的不同时点T1、T2、T3、T4的ANI数值及血流动力学均有明显的变化(P<0.05),其中以最强的疼痛刺激时点穿刺器刺入腹腔T2时间点的变化最为显著(P<0.001)。结论在吸入全麻下腹腔镜胆囊切除手术中,ANI的数值变化与伤害性刺激密切相关,能够及时反应全麻患者的镇痛水平。Objective To evaluate the performance of analgesia nociception index （ANI） measured during general anesthesia with inhalational anesthetics for laparoscopic cholecysteetomy. Methods 32 ASAI - II patients undergoing laparoscopic choleeystectomy with general anesthesia using sevofluraue were included in this observational study. The depth of anesthesia was maintained from DO to D2 by Narcotrend （NT） monitoring. The ANI （100 maximum optimal value, 0 minimal value） as well as mean blood pressure （MAP） and heart rate （HR） were observed at 5 different time point ： no nociceptive stimuli after induction （T0）, laparoseopic pneumoperitoneum （TI）, trocar puncture into the abdomen （rlE）, gallbladder bed dissection （T3）, gallbladder removal from abdomen （T4）. Results With the same anesthesia depth, ANI decreased significantly （P 〈 0. 05） in nociception point T1, T2, 33 and T4, compaired with no stimuli point （TO）. The most intense painful stimulation is trocar puncture into the abdomen （T2） of which ANI decreased most rapidly and significantly （40. 0 ± 11.4, P 〈 0. 001 ）. Conclusions ANI appears to reflect differ- ent levels of stimulation during sevofluraue based general anesthesia.

关 键 词：镇痛-伤害性刺激指数 心率变异性 全身麻醉 

分 类 号：R614.2[医药卫生—麻醉学]