全麻期间不同强度伤害性刺激下镇痛/伤害性刺激指数的变化及其相关性分析

Variations and correlation analysis of analgesia nociception index(ANI)under different levels of nociception during general anesthesia

目的 评价镇痛/伤害性刺激指数（ANI）作为一种全新的反映伤害性刺激的监测指标在全麻期间在不同强度伤害性刺激下的变化及其相关性。方法 拟行择期全麻腰椎后路椎板切除减压植骨内固定术的成年患者37例,ASAⅠ或Ⅱ级。采用丙泊酚及瑞芬太尼双靶控输注行麻醉诱导和维持,调整丙泊酚血浆靶浓度维持BIS在40-60,依据循环变化调整瑞芬太尼靶浓度。记录特定时点（麻醉诱导后无刺激点、切皮、神经根牵拉）的SBP、HR和ANI等相关数据。ANI、SBP及HR组内比较采用单因素方差分析,Spearman等级相关分析比较ANI、SBP和HR与伤害性刺激强度的相关性,采用偏相关分析评价ANI与SBP及HR的相关性。结果 30例患者完成研究。切皮及神经根牵拉时ANI下降,SBP明显升高（P〈0.05）,而HR无显著变化。ANI与伤害性刺激水平的相关性较SBP和HR高（r=-0.866vs r=0.717、0.056）;ANI与HR之间无明显相关性,ANI与SBP之间有一定的负相关性（r=-0.563,P〈0.01）。结论 在全麻腰椎后路手术中,ANI能够较为准确可靠地反映伤害性刺激强度的变化,且与伤害性刺激强度具备很好的相关性。

Objective To assess the changes and correlation of analgesia nociception index（ANI）under different levels of nociceptive stimulations during general anesthesia.Methods ASA ⅠorⅡ,thirty-seven adult patients undergoing posterior lumbar laminectomy interbody infusion and internal fixation were included.Propofol and remifentanil were administered using target-controlled devices during anesthesia induction and maintenance.The propofol target concentration was adjusted in order to keep bispectral index（BIS）in the 40-60 range,and the target concentration of remifentanil was adapted according to hemodynamic fluctuation.All parameters（HR,SBP and ANI values）were recorded and collected at predefined time,including Nostim,Incision and Nerve Root Traction.One way ANOVA for multiple comparisons,Spearman rank correlation coefficient was used to compare nociception levels with ANI,SBP and HR.and partial correlations was performed between ANI and SBP,HR.Results Thirty patients completed the study.Incision and Nerve Root traction lead to decrease in ANI values and increase in SBP values（P〈0.05）,while there was no significant change in HR values.Correlation coefficients for nociception levels was higher for ANI（r=-0.866）than for SBP（r=0.717）and HR（r=0.056）.ANI correlated negatively with SBP,but ANI did not correlate with HR.Conclusion ANI can be used to reflect variation of nociception levels fairly,and it correlates well with the intensity of nociceptive stimulations.