AEPindex和HRV用于术后PCA期间病人镇痛效应和镇静程度的监测与评价

Comparison of auditory evoked potential index and heart rate variability for monitoring the level of sedation and analgesia during PCEA

目的 应用 AEPindex、BIS、HRV、SEF等监测指标,定量分析评价术后不同负荷剂量PCEA病人的镇痛效应和镇静程度。方法 全麻下行择期上腹部手术的病人30例（ASAI—Ⅱ级）随机分为三组,I组（n=10）:0.2％罗哌卡因+0.01％吗啡,以LCP模式给药;Ⅱ组（n=10）:药液和方法同I组,但负荷剂量5ml内含可乐定100μg;Ⅲ组（n=10）:负荷剂量含咪唑安定2ing。观察AEPindex、BIS、HRV、SEF、VAS、OAA/S等在不同时点的数值与评分变化。结果（1）三组PCEA病人术后清醒述痛时AEPindex值明显高于术前1d的基础值（P<0.05）,给予负荷剂量后AEPindex值下降,与疼痛时比较有显著性差异（P<0.05）;（2）各组 AEPindex、BIS数值变化趋势与 OAA/S评分均呈正相关（P<0.05）;I组HRV值与OAA/S评分相关性差（P>0.05）,Ⅱ组、Ⅲ组的HRV数值变化趋势与OAA/S评分呈正相关（P<0.05）。（3）三组AEPindex、BIS、HRV在给予负荷剂量后60min内,其数值变化与VAS评分呈正相关。结论AEPindex对疼痛刺激反应敏感,可定量反映PCEA对病人的镇痛效应和镇静程度,HRV可特异反映疼痛及镇痛药对自主神经功能的影响。

Objective To compare auditory evoked potential index (AEPI) , BIS , heart rate variability (HRV) and spectral edge frequency (SEF) for monitoring the level of analgesia and sedation produced by different analgesic mixture of PCEA. Methods Thirty ASA Ⅰ-Ⅱ patients undergoing upper abdominal surgery under general anesthesia were enrolled in the study.Patients with mental or hearing disorders were excluded. The patients were randomly divided into three groups . The basic analgesic mixture for PCEA was 0.2% ropivacaine + 0.01% morphine in the 3 group and the PCEA regimen was : loading dose 5ml , background infusion 1ml·h-1, bolus dose 1ml and lock-out interval 10 min. The difference among the 3 groups was that the 5ml loading dose contained clonidine l00μg in group Ⅱ or midazolam 2mg in group Ⅲ. The patients were premedicated with phenobartital and scopolamine. Epidural catheter was placed at T9-10 , a test dose of 1 % lidocaine 3-5ml was given to confirm the correct placement of the epidural catheter. General anesthesia was induced with midazolam 0.06mg·kg-1, fentanyl 4μg·kg-1, propofol 0.5mg·kg-1 and vecuronium 0.1mg·kg-1. Anesthesia was maintained after tracheal intubation with isoflurane inhalation and propofol infusion. Patients were transported to PACU after operation.PCEA was started after extubation when the patients was awake and complained of pain. The AEPI, BIS , HRV and SEF values and VAS, OAA/S scores were recorded before induction of anesthesia (T0 ) at the end of surgery (T1), 5, 15, 30 , 60 , 90 min and 2h, 4h, 8h, 20h, 24h after loading dose (T2-12). Results (1) AEPI was significantly higher than the baseline value when the patient was awake and feel pain ( P < 0.05) but decreased after loading dose in all 3 groups (P<0.05). (2)In each group the trend of changes in AEPI and BIS values correlated positively with OAA/S scores. The HRV value correlated poorly with OAA/S scores in group I but in groupⅡ and Ⅲ, the trend of change in HRV correlated positively withOAA/S scores. (3) The trend of changes in AEPI, BIS and HRV values correlated positively with VAS scores within 60 min after the loading dose in all 3 groups .Conclusion AEPI is sensitive to pain stimulation and can be used for monitoring the level of analgesia and sedation. HRV reflects the effect of pain and analgesia on autonomic nervous system.