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直觉痛觉定量分析仪在预测气管插管反应中的应用
Painvision for the prediction of the response of endotracheal intubation
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DOI:
作者:
吕娟,陈辉,沈祎蕾,封莉莉,熊源长
Lvjuan, Shenyi-lei, Chen hui, Xiongyuan-chang
作者单位:
长海医院
Department of Anesthesiology, Changhai Hospital, Second Military Medical University, Shanghai
关键词:
感知阈;痛阈;直觉痛觉定量分析仪;气管插管;血流动力学变化
Sensing threshold;Pain threshold;Painvision;Endotracheal intubation;Hemodynamic change
摘要:
摘要 目的:通过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变化,探索其预测气管插管反应的可行性及准确性。方法:选取美国麻醉医师协会(ASA)Ⅰ~Ⅱ级术前肛肠外科患者50例,入室后心电监测,PAINVISION测量患者静脉注射芬太尼(3μg/kg)前后感知阈(S)和痛阈(P)。记录入室(T0)、PAINVISION两次测量时(T1、T2)以及气管插管前即刻(T3)和插管后1min(T4)患者收缩压、心率。计算注射芬太尼前后患者感知阈、痛阈前后变化率(ST%、PT%)及气管插管前后收缩压、心率的变化。观察芬太尼给予前后患者感知阈、痛阈、插管前后血压心率的变化,分析变化值与插管反应之间的关系。用SPSS 17.0软件对测得的数据进行统计学分析。结果:1.芬太尼注射后,患者感知阈、痛阈均明显提高(P<0.001)。2.芬太尼注射前后痛阈变化率(PT%)与插管前后心率变化的相关系数r=-0.885,与插管前后收缩压变化的相关系数r=-0.802。3.根据受试者工作曲线(ROC)确定PT%最佳界值为50%,以50%分成两组G1(PT%<50%)、G2(PT%≥50%)。G1组插管反应阳性率为95%,G2组插管反应阳性率为23.3%,两组相比,插管反应差异有显著意义,P<0.001。结论:1. PAINVISION操作方便,患者易耐受,短时间内可评估疼痛值,相对客观。2.静脉注射芬太尼3μg/kg后,患者感知阈、痛阈明显提高,并且痛阈提高越明显,插管时心血管反应越小。痛阈前后提高大于50%的患者,其插管时心血管反应明显减小。但感知阈与插管反应关系不大。3.对于应避免插管应激的患者,我们可以应用PAINVISION作为筛选工具,提前预测并通过给予适当剂量的阿片类药物以达到减少插管时心血管反应的目的。
Objective: To evaluate the feasibility and accuracy of PAINVISION in endotracheal intubation by measuring the Sensing threshold (S) and pain threshold (P)of the patients before and after been given fentanyl, in order to reduce the intubation reactions during the anesthesia induction. Methods: 50 ASA physical statusⅠ-Ⅱ patients before anorectal operations. We Observed the relationships between the changes of S and P of the patients before and after fentanyl been given and the changes of SBP and HR before and after end otracheal intubation. We measured the datas with SPSS 17.0 software for statistical analysis. Results: 1.After injecting fentanyl, S and P of the patients improved significantly(P=0.001). 2.There was a significant correlation between the change rate of the pain threshold(PT%) and the change rate of HR ,the coefficient of correlation of was -0.885; and the coefficient of correlation of the change rate of SBP and PT%was-0.802. 3. With PT% =50% for the industry, we divided the patients into two groups of G1 (P%<50%), G2 (P%≥50%).G1 group intubation response positive rate was 95%, G2 group intubation response positive rate was 23.3%.When P%≥50%,we can predict that the Intubation reaction would be little (P=0.001).Conclusion: 1.The PAINVISION has a convenient operation, it is easy to tolerance for the patients. It cost a short time to assessment pain value, and the results were relatively objective.2.After injecting fentanyl(3 ug/kg), ST% and PT% improved significantly. The more significantly improving of PT%, the little intubation reaction happened. When PT%≥50%,we can predict that the Intubation reaction would be little.3.When some patients have endotracheal intubation difficulties, to avoid intubation response, we can apply PAINVISION as a screening tool to predict in advance,in order to reduce intubation response.
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