PTI、IoC2和SPI在全身麻醉患者镇痛深度监测中的价值

目的探讨镇痛指数(PTI)、伤害敏感指数(IoC2)和手术容积指数(SPI)在全身麻醉患者镇痛深度监测中的价值。方法选取择期行腹腔镜胆囊切除术患者90例,采用区组随机法,按照不同镇痛深度监测指标分为IoC2组(A组)、SPI组(B组)和PTI组(C组),每组各30例。记录并比较各时间点患者心率(HR)、平均动脉压(MAP)、IoC2、SPI、PTI,测定并比较术前、术中和术后血清炎症因子(IL-6、IL-10)的水平。结果T2时IoC2、SPI和PTI与T1时比较(P<0.001);T3时SPI和PTI与T2时比较(P<0.05);T4时PTI和SPI与T3时比较(P<0.05);T4时IoC2与T2、T3时比较(P<0.001);T6时SPI和PTI与T5时比较(P<0.05);T7时IoC2、SPI、PTI与T5时比较(P<0.05);T8时IoC2、SPI和PTI与T7时比较(P<0.05)。各组内比较,IoC2、SPI和PTI具有时间变化趋势,且随着时间点不同均发生变化(P<0.001)。三组组间比较,HR、MAP、IoC2、SPI和PTI时间与组间存在交互效应,具有不相等的变化趋势(P<0.001)。IoC2、SPI、PTI与HR和MAP均呈正相关(P<0.05)。三组患者IL-6和IL-10术前、术中和术后比较,差异无统计学意义(P>0.05)。结论IoC2、PTI和SPI可作为全身麻醉术中疼痛监测的可靠指标,减轻术中应激反应,准确性优于HR、MAP。

Objective To explore the value of pain threshold index(PTI),index of consciousness2(IoC2)and surgical pleth index(SPI)in monitoring the depth of analgesia in general anesthesia patients.Methods Ninety patients undergoing elective laparoscopic cholecystectomy were selected and divided into IoC2 group(Group A),SPI group(Group B),and PTI group(Group C)according to different analgesic depth monitoring indexes by the block group randomization method.Heart rate(HR),mean pressure(MAP),IoC2,SPI and PTI of patients at each time point were recorded and compared,and the levels of serum inflammatory factors(IL-6,IL-10)were measured and compared before,during and after surgery.Results Comparison of IoC2,SPI,and PTI at T2 with T1(P<0.001).Comparison of SPI and PTI at T3 with T2(P<0.05).Comparison of PTI and SPI at T4 with T3(P<0.05).Comparison of IoC2 at T4 with T2 and T3(P<0.001).Comparison between SPI and PTI at T6 and T5(P<0.05).Comparison of IoC2,SPI,PTI at T7 and T5(P<0.05).Compare IoC2,SPI,and PTI at T8 with those at T7(P<0.05).Comparing within each group,IoC2,SPI and PTI had a time trend and all changed with different time points(P<0.001).Comparison among the three groups,HR,MAP,IoC2,SPI and PTI had unequal trends(P<0.001).IoC2,SPI and PTI were positively correlated with HR and MAP(P<0.05).There was no statistically significant difference between preoperative,intraoperative and postoperative comparisons of IL-6 and IL-10 in the three groups(P>0.05).Conclusion IoC2,PTI and SPI can be used as reliable indicators for intraoperative pain monitoring in general anesthesia to alleviate intraoperative stress reactions,with better accuracy than HR and MAP.