瞳孔直径变化对术后疼痛评估的价值  

Significance of pupillary diameter variation in assessment of postoperative pain

作　　者：谢海[1] 李艳[2] 吴多志[2] 周期[1] 陈勇[2] 马乃全[1] 

机构地区：[1]海南医学院附属医院麻醉科,海口市570102 [2]海南省人民医院麻醉科

出　　处：《临床麻醉学杂志》2016年第2期134-138,共5页Journal of Clinical Anesthesiology

基　　金：海南省卫生厅科学研究课题(编号15A200004)

摘　　要：目的通过观察术后患者瞳孔直径变化对数字疼痛强度量表评分的反应性,探讨瞳孔直径变异度对术后疼痛评估的评判价值。方法选择择期全麻下手术术后患者80例,男43例,女37例,年龄24-79岁,ASAⅠ-Ⅲ级。入PACU后评估数字疼痛强度量表（numerical rating scale,NRS）评分。当NRS评分为0-3分时,不作镇痛处理;NRS评分为4-10分5min后静脉单次注射芬太尼50μg。记录NRS评分开始20min内每分钟的NRS、瞳孔直径（pupillary diameter,PD）、SBP和HR值,计算NRS评分均为0-3分10min内时,NRS评分由0-3分变为4-10分后5min内时,NRS评分由4-10分变为0-3分后5min内时,NRS评分均为4-10分10min内时的最大变化率（Δmax）,分别记为ΔPD、ΔSBP、ΔHR。以NRS评分变化作为评判标准,通过受试者工作特征曲线（ROC曲线）分析ΔPD、ΔSBP和ΔHR对NRS的反应性,寻找诊断临界值（cutoff值）。结果与NRS评分为0-3分时比较,NRS评分为4-10分时的PD明显增大、SBP明显升高、HR明显增快（P〈0.05）。ΔPD、ΔSBP和ΔHR的曲线下面积（AUC）分别为：AUCΔPD0.904（95%CI 0.822-0.987）、AUCΔSBP0.651（95%CI 0.510-0.781）和AUCΔHR0.588（95%CI 0.444-0.733）;AUCΔPD明显大于AUCΔSBP和AUCΔHR（P〈0.05）;当ΔPD的cutoff值为41.3%时,敏感度80.0%,特异度93.5%;当ΔSBP的cutoff值为10.3%时,敏感度62.4%,特异度71.5%。结论ΔPD比ΔSBP、ΔHR对术后疼痛/镇痛的评价具有更高的准确性,是评估术后疼痛/镇痛平衡的有价值指标。Objective To observe the reactivity of pupillary diameter variation responding to numerical rating scale on postoperative pain to explore the accuracy of pupillary diameter variation for pain assessment.Methods Eighty patients after selected surgery（male 43 cases,female 37 cases,aged24-79 years,ASA gradeⅠorⅡ）were included for the trial.After endotracheal extubation and on arrival in the post-anaesthesia care unit（PACU）,the levels of pain on numerical rating scale（NRS）were rated and recorded subsequently.If NRS was within 0-3,no analgesic was administered and 50μg fentanyl was administrated after 5min if NRS rated in 4-10.The pupillary diameter（PD）,systolic blood pressure（SBP）and heart rate（HR）were recorded every minute during 20 minute after first NRS evaluation,the corresponding maximum variation of above index were calculated simultaneously in 10 minutes with NRS 0-3,after 5minutes with NRS 0-3to 4-10,after 5minutes with NRS 4-10to0-3,in 10 minutes with NRS 4-10 which were marked respectively withΔPD,ΔSBP andΔHR.With the variation of NRS as a criterion,the reactivity ofΔHR,ΔSBP andΔPD responding to NRS variation were assessed by analysing the receiver operating characteristic curve（ROC）,the area under the receiver operating characteristic curve（AUC）was calculated.Results The patients′ROC value ofΔHR,ΔSBP and ΔPD responding to NRS variation were AUCΔPD0.904（95%CI 0.822-0.987）,AUCΔSBP0.651（95%CI 0.510-0.781）and AUCΔHR0.588（95%CI 0.444-0.733）respectively.Value of AUCΔPD was larger than that of AUCΔSBPand AUCΔHRrespectively（P〈0.05）.Importantly,operating characteristic curve（ROC）analysis showed that the diagnostic cutoff value ofΔPD was 41.3%with a sensitivity of 80.0% and a specificity of 93.5% and the diagnostic cutoff value ofΔSBP was10.3% with a sensitivity of 62.4% and a specificity of 71.5%.Conclusion This study demonstrated that the accuracy ofΔPD was higher thanΔSBP andΔHR responding to pain/analgesia evaluation.ΔPD was a valua

关 键 词：疼痛 数字疼痛强度量表 瞳孔扩张反射 瞳孔直径 

分 类 号：R614.2[医药卫生—麻醉学]