手术体积描计指数预测小儿全麻下腺样体扁桃体切除术后早期疼痛的初步探讨  

A preliminary study on the surgical pleth index predicting postoperative early pain in children undergoing adenotonsillecto⁃my under general anesthesia

作　　者：李琳[1] 孟庆花 田蔼萍[1] 张维智[1] Li Lin;Meng Qinghua;Tian Aiping;Zhang Weizhi(Department of Anesthesiology,Children's Hospital of Shanxi Province,Taiyuan 030013,China)

机构地区：[1]山西省儿童医院麻醉科,太原030013

出　　处：《国际麻醉学与复苏杂志》2024年第12期1238-1242,共5页International Journal of Anesthesiology and Resuscitation

基　　金：山西省自然科学基金面上项目(202203021221290)。

摘　　要：目的探讨手术体积描计指数(SPI)预测小儿全麻下腺样体扁桃体切除术后疼痛的可行性。方法选取择期行全麻下腺样体扁桃体切除术的患儿120例,性别不限,年龄4~8岁,美国麻醉医师协会(ASA)分级Ⅰ、Ⅱ级。患儿入手术室后监测无创血压、心电图、脉搏血氧饱和度(SpO2)和SPI。所有患儿均给予气管插管全麻,术中维持SPI在20~50。手术结束前5 min停止输注麻醉药物,分别记录手术结束即刻及手术结束后1、2、3、4、5 min时患儿的平均动脉压(MAP)、心率(HR)及SPI,取最大值,分别为MAPmax、HRmax、SPImax。患儿气管导管拔除后送入麻醉后监测治疗室(PACU)继续观察,入PACU后10、20、30 min采用改良加拿大安大略儿童医院疼痛评分量表(m⁃CHEOPS)对患儿进行疼痛评分,取评分最大值进行分析。根据患儿是否发生中⁃重度疼痛分别绘制MAPmax、HRmax、SPImax的受试者操作特征(ROC)曲线。结果112例患儿完成试验。患儿入PACU后30 min内有89例为无痛或轻度疼痛(79.5%),18例出现中度疼痛(16.1%),5例出现重度疼痛(4.4%)。ROC曲线显示:SPImax曲线下面积(AUC)为0.83,敏感度和特异度分别为78.8%和86.8%,预测发生中⁃重度疼痛的效能较好,SPI的最佳截断值为44.5;MAPmax和HRmax的AUC分别为0.55和0.61,二者均不能预测患儿术后中⁃重度疼痛的发生。结论SPI可以有效预测小儿全麻下腺样体扁桃体切除术后早期中⁃重度疼痛的发生。Objective To explore the feasibility of surgical volume index(SPI)in predicting postoperative pain in children un⁃dergoing adenotonsillectomy under general anesthesia.Methods A total of 120 children aged 4 to 8 years,boys or girls,the Ameri⁃can Society of Anesthesiologists(ASA)gradesⅠorⅡ,who were scheduled for elective adenotonsillectomy under general anesthesia were selected.Non⁃invasive blood pressure,electrocardiogram,pulse oxygen saturation(SpO2),and SPI were monitored after the chil⁃dren entered the operating room.All patients received tracheal intubation for general anesthesia,and SPI was maintained between 20 and 50 during the surgery.Five minute before the end of the surgery,the infusion of anesthetics was stopped.The average arterial pres⁃sure(MAP),heart rate(HR),and SPI were recorded immediately at the end of surgery and at post⁃operation 1,2,3,4 min and 5 min,with the maximum values defined as MAPmax,HRmax,and SPImax,respectively.After extubation,rgw patients were transferred to the post⁃anesthesia care unit(PACU)for continued observation.Pain was assessed using the modified Children's Hospital of Eastern Ontar⁃io Pain Scale(m⁃CHEOPS)at 10,20 min and 30 min in PACU,and the maximum scores were analyzed.Based on the occurrence of moderate to severe pain,receiver operating characteristic(ROC)curves were plotted for MAPmax,HRmax,and SPImax.Results The tri⁃al was completed in 112 children.Within 30 min after entering PACU,89 children(79.5%)had no pain or mild pain,18(16.1%)expe⁃rienced moderate pain,and 5(4.4%)experienced severe pain.The ROC curves showed that the area under the curve(AUC)for SPImax was 0.83,with a sensitivity of 78.8%and specificity of 86.8%,indicating good predictive efficiency for moderate to severe pain;the op⁃timal cutoff value for SPI was 44.5.In contrast,the AUC for MAPmax and HRmax was 0.55 and 0.61,respectively,indicating that neither could predict the occurrence of moderate to severe pain postoperatively.Conclusion SPI can effectively predict the early

关 键 词：手术体积描计指数 小儿 麻醉 全身 腺样体扁桃体切除术 术后疼痛 

分 类 号：R47[医药卫生—护理学]