腹腔镜腹部外科手术全身麻醉时镇痛/伤害性刺激指数的变化研究

Variations of the analgesia nociception index during general anaesthesia for laparoscopic abdominal surgery

摘要:

探讨镇痛/伤害性刺激指数（ANI）能否准确反映麻醉过程中镇痛/伤害性刺激变化相关事件，尤其是心率（HR）和血压等血流动力学参数的变化。方法 纳入53例在该院接受腹腔镜阑尾切除术和胆囊切除术且行全麻的成年患者。比较行全麻患者伤害性刺激时ANI、HR及心脏收缩压（SBP）。患者麻醉诱导采用多模式静脉麻醉工作站双通道靶控输注（TCI）丙泊酚和瑞芬太尼，设定丙泊酚的血浆靶浓度（ProCp）为2μg/ml，如发生血流动力学反应（Hemod React）则调整丙泊酚剂量，血流动力学反应是指HR或SBP升高20%以上。在预先设定的7个时间点，采集患者ANI和血流动力学数据。结果 麻醉诱导时HR和SBP下降，而ANI值较高（81.6±11.2），提示副交感神经占优势。患者术前接受强直刺激，强直刺激5 min内，39例患者ANI值由（81.6±11.2）降至（58.6±11.7），而HR和SBP未改变。气腹建立后，ANI继续下降至（50.2±15.8），而HR及SBP明显增加。手术完成后，ANI恢复至（90.1±3.4），与术前无差异。结论 接受异丙酚麻醉患者的ANI值对中等疼痛刺激的敏感性高于HR和SBP，ANI监测能够有效协助接受异丙酚-瑞芬太尼全身麻醉的成年患者行腹腔镜腹部外科手术。

Abstract:

Abstract: Objective To test whether the analgesia nociception index (ANI) was coherent with events related with changes in the antinociception/nociception balance during anaesthesia, especially in comparison with usual haemodynamic parameters such as HR and systolic blood pressure (SBP). Methods 53 adult patients who underwent laparoscopic appendectomy and cholecystectomy under general anesthesia in our hospital were included in this study. Analgesia nociception index (ANI), heart rate (HR) and systolic blood pressure (SBP) in patients under general anesthesia were compared during noxious stimuli. The induction of anesthesia adopted the dual-channel target-controlled infusion (TCI) of Propofol and Remifentanil based on the multimode intravenous anesthesia workstation. The plasma Propofol concentration (ProCp) was set to 2 μg/ml and the dose of Propofol would be adjusted if hemodynamic responses (Hemod Resp) occurred. Hemodynamic response referred to the condition that HR or SBP increased by more than 20 percent. Patients’ ANI and hemodynamic data were collected at 7 preset time points. Results During the induction of anesthesia, HR and SBP decreased while the ANI value was high (81.6 ± 11.2), suggesting the parasympathetic predominance. Patients received preoperative tetanic stimulation. In the 5 minutes of tetanic stimulation, the patients ANI value decreased from (81.6 ± 11.2) to (58.6 ± 11.7), while HR and SBP did not change. After the establishment of pneumoperitoneum, the ANI further decreased to (50.2 ± 15.8) while HR and SBP had obvious increase. After the completion of the operation, the ANI returned to (90.1 ± 3.4). No difference was observed between the values before and after operation. Conclusion The ANI values of patients receiving Propofol anesthesia had higher sensitivity to moderate pain stimuli than to HR and SBP. The ANI monitoring is effective in assisting the laparoscopic abdominal surgery for Adult patients under general anesthesia with Propofol and Remifentanil.