灌注指数评估ICU机械通气患者疼痛的有效性研究

Efficacy of perfusion index in evaluating pain of patients in ICU who received mechanical ventilation

目的评价灌注指数(PI)作为ICU机械通气患者疼痛评估工具的有效性。方法选取2021年3月至2022年3月南京鼓楼医院重症医学科收治的87例患者为研究对象。应用迈瑞BeneVision N17监护仪进行持续PI监测和生命体征监测,采用重症监护疼痛观察量表(CPOT)进行疼痛评估。比较患者有疼痛表现、CPOT评分>1分时(镇痛前)和患者疼痛缓解、CPOT评分≤1分时(镇痛后)的PI、CPOT、心率(HR)、血压、呼吸频率(RR)、血氧饱和度、体温。采用Spearman秩相关分析各变量变化值之间的相关性。结果与镇痛前比较,镇痛后患者PI值明显升高,HR、收缩压、舒张压、平均动脉压(MAP)、RR、CPOT评分均降低,差异均有统计学意义(均P<0.05)。PI变化值与CPOT变化值、HR变化值(ΔHR)均呈负向弱相关(r_(s)=-0.236和-0.239,均P<0.05),ΔHR与MAP变化值呈正向弱相关(r_(s)=0.289,P<0.05),其余指标之间均无相关性(均P>0.05)。结论ICU有创机械通气患者的疼痛减轻后,PI值会升高,两者之间存在相关性,PI可以作为ICU机械通气患者的疼痛评估工具。

Objective To evaluate the efficacy of perfusion index(PI)as a pain assessment tool for ICU patients who received mechanical ventilation.Methods A total of 87 inpatients admitted to the Department of Intensive Care Unit of Nanjing Drum Tower Hospital from March 2021 to March 2022 were selected as the study objects.The Mindray BeneVision N17 monitor was used for continuous PI monitoring and vital signs monitoring.The critical care pain observation tool(CPOT)was used to evaluate pain.PI,CPOT,heart rate(HR),blood pressure,respiratory rate(RR),pulse oximeter oxygen saturation and temperature of patients were recorded and compared when patients had pain and CPOT score>1(before analgesia)and when they had pain relief and CPOT score≤1(after analgesia).Spearman rank correlation was used to analyze the correlation between the change values of each variable.Results Compared with the conditions before analgesia,PI value of patients after analgesia was significantly increased,HR,systolic blood pressure,diastolic blood pressure,mean arterial pressure(MAP),RR and CPOT score were all decreased,with statistical significance(all P<0.05).ΔPI was negatively weakly correlated withΔCPOT andΔHR(r_(s)=-0.236 and-0.239,both P<0.05),whileΔHR was positively weakly correlated withΔMAP(r_(s)=0.289,P<0.05);there was no correlation among the other indexes(all P>0.05).Conclusion PI values increase after pain relief in ICU patients who received invasive mechanical ventilation;there is a correlation between changes of the two.PI can be used as a pain assessment tool for patients in ICU who received mechanical ventilation.