镇痛/伤害刺激指数与宫腔镜腰麻后低血压的相关性研究

Correlationship Between Analgesia Nociception Index and Hypotension After Spinal Anesthesia in Patients Undergoing Hysteroscopic Surgery

目的探讨镇痛/伤害刺激指数(analgesia nociception index,ANI)与宫腔镜手术患者腰麻(spinal anesthesia,SA后低血压发生的相关性。方法纳入60例美国麻醉医师学会(American Society of Anesthesiology,ASA)分级Ⅰ或Ⅱ级择期行妇科宫腔镜手术的患者,入室后平静5 min,检测收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)和心率(heart rate,HR),应用MetroDoloris监测仪监测ANI,快速输入乳酸钠林格液10 ml/kg后实施腰麻,腰麻用药为重比重布比卡因12. 5 mg(身高<160 cm)或15 mg(身高≥160 cm)。记录入室后基础值、腰麻后即刻及腰麻后5 min、10 min、15 min、20 min和30 min时SBP、DBP和ANI,并计算各时点SBP与基础值的差值。根据腰麻后SBP下降幅度是否大于20%分为低血压组(SBP下降幅度> 20%)和非低血压组(SBP下降幅度≤20%)。通过logistic回归拟合ANI与低血压发生率的剂量-反应关系,探讨麻醉前ANI数值与腰麻后低血压发生的相关性。结果低血压组麻醉前ANI明显低于非低血压组(P<0.01);剂量-反应曲线显示,随着腰麻前ANI数值增加,麻醉后低血压发生率下降; logistic回归模型表明,术前ANI低于50的宫腔镜腰麻患者为腰麻后发生低血压的高危患者,高于60为低危患者,50～59为中危患者。结论腰麻前ANI数值与麻醉后低血压的发生具有一定相关性,随着腰麻前ANI数值增加,麻醉后低血压发生率下降。

Objective To investigate the correlationship between analgesia nociception index(ANI)and hypotension after spinal anesthesia(SA)in patients undergoing hysteroscopic surgery.Methods Sixty patients with American Society of Anesthesiology(ASA)gradeⅠorⅡscheduled for elective hysteroscopic operation under SA were enrolled in this study.Systolic blood pressure(SBP),diastolic blood pressure(DBP),and heart rate(HR)were measured after patients arrived in the operating room and remained calm for 5 minutes.The ANI was monitored by the MetroDoloris system.SA was performed with a volume of hyperbaric bupivacaine 0.5%adjusted according to the patient’s height(12.5 mg,height<160 cm;15 mg,height≥160 cm)after rapidly infusing lactate-linger solution(10 ml/kg).The SBP,DBP,HR,and ANI were recorded immediately after SA and at 5 min,10 min,15 min,20 min,and 30 min after SA.The difference of SBP between each time point and the basic value was calculated.The patients were allocated into two groups depending on the decreasing degree of SBP:hypotensive group(decreasing degree of SBP>20%)and non-hypotensive group(decreasing degree of SBP≤20%).Dose response curve and logistic regression were applied to explore the relationship of ANI and hypotension after SA.Results Preanesthetic ANI in the hypotensive group was significantly lower than that in the non-hypotensive group(P<0.01).The dose response curve indicated that the incidence of hypotension after SA decreased with the increase of preanesthetic ANI.Furthermore,the model of logistic regression showed that patients with preanesthetic ANI less than 50 were high-risk patients with hypotension after SA,patients with preanesthetic ANI more than 60 were low-risk patients,and those with preanesthetic ANI between 50 and 59 were medium-risk patients.Conclusion ANI before anesthesia correlates with hypotension after SA,and the incidence of hypotension after SA may decrease with the increase of preanesthetic ANI.