知觉痛觉定量分析仪在预测气管插管反应中的应用  

PainVision for predicting endotracheal intubation response

作　　者：吕娟[1] 陈辉[1] 沈祎蕾[1] 封莉莉[1] 熊源长[1] 

机构地区：[1]上海长海医院麻醉科,上海200433

出　　处：《上海医学》2014年第10期823-826,共4页Shanghai Medical Journal

摘　　要：目的应用知觉痛觉定量分析仪(PainVision)测定给予芬太尼前后患者电流感知程度的变化,探索其预测气管插管反应的可行性和准确性。方法选取美国麻醉医师学会(ASA)分级Ⅰ或Ⅱ级的肛肠外科术前患者50例,入手术室后进行心电监测,应用知觉痛觉定量分析仪测定患者静脉注射芬太尼(3μg/kg)前后的感知阈和痛阈,并计算变化率。在进入手术室(T0)、两次测定感知阈和痛阈时(T1、T2)、气管插管前即刻(T3)和气管插管后即刻(T4)各时间点,记录患者的收缩压(SBP)和心率(HR),并计算气管插管前后SBP和HR的变化。分析气管插管时心血管反应与感知阈变化率(ST%)和痛阈变化率(PT%)之间的关系。根据受试者工作特征曲线(ROC曲线)确定PT%的最佳判断阈值,并计算该阈值的敏感度、特异度、阳性预测值和阴性预测值。结果 T4时间点的SBP显著高于T3时间点(P<0.05),HR显著快于T3时间点(P<0.05)。芬太尼注射后的感知阈和痛阈分别为30.96±27.33和72.69±44.77,均显著高于注射前的13.46±8.72和43.54±29.65(P值均=0.000)。ST%与气管插管前后SBP和HR的变化均不相关(r=0.230、0.268,P值均>0.05),PT%与气管插管前后SBP和HR的变化均呈负相关(r=-0.802、-0.885,P值均<0.05)。根据ROC曲线确定PT%最佳界值为50%,此值的灵敏度为73.1%,特异度为95.8%,阳性预测值为95.0%,阴性预测值为76.7%,正确指数(灵敏度+特异度-1)为68.9%。PT%<50%组气管插管反应阳性19例、阴性1例,PT%≥50%组气管插管反应阳性7例、阴性23例,两组间差异有统计学意义(χ2=24.693,P=0.000)。结论知觉痛觉定量分析仪操作方便,患者易耐受,短时间内可评估疼痛值,相对客观。静脉注射芬太尼3μg/kg后,患者的感知阈、痛阈明显提高;且痛阈提高越明显,气管插管时的心血管反应越小,PT%≥50%者在气管插管时发生心血管反应的构成比明显低于PT%<50%者;但感知阈与气管插管反应的关系不大�Objective To evaluate the feasibility and accuracy of PainVision in endotracheal intubation by measuring sensing threshold and pain threshold before and after fentanyl infusion. Methods Fifty patients, American Society of Anesthesiologists （ASA） physical status Ⅰ or Ⅱ, undergoing anorectal operations, were enrolled in the present study. Electrocardiograph monitoring was performed when patients entered the operating room. The sensing threshold and pain threshold were measured by PainVision before and after intravenous injection of fentanyl 3 μg/kg. Systolic blood pressure （SBP） and heart rate （HR） were recorded at the following time points; after patients entering operating room （T0）, when sensing and pain thresholds were measured before （T1） and after （T2） fentanyl infusion, before （T3） and after （T4） endotracheal intubation. The changes of SBP and HR before and after endotracheal intubation were calculated. The relationship between cardiovascular responses during intubation and sensing threshold rate （ST%） and pain threshold rate （PT%） was analyzed. The best threshold of PT% was determined according to the receiver-operating characteristic curve （ROC curve）, and the sensitivity, specificity, positive predictive value and negative predictive value of the optimal threshold were calculated.Results SBP and HR at T4 were significantly higher than those at T3 （both P〈0.05）. The sensing threshold and pain threshold were 30.96 ± 27. 33 and 72. 69 ± 44. 77 after fentanyl injection, respectively, which were significantly more than those before fentanyl injection （ 13.46±8.72, 43.54± 29.65, both P = 0. 000）. There was no correlation between the ST% and the changes of SBP or HR （r = 0. 230, r = 0. 268, both P〉0.05）. The PT% was negatively correlated with the changes of SBP and HR （r = -0. 802, r = -0. 885, both P〈0.05）. The best threshold of PT% was 50%. The sensitivity, specificity, positive predictive value, negative predictive value, and correct i

关 键 词：感知阈 痛阈 知觉痛觉定量分析仪 气管插管 血流动力学变化 

分 类 号：R614[医药卫生—麻醉学]