CAJ | 학술논문

目的初步探讨镇痛/伤害性刺激指数(ANI)评估胸腔镜肺叶切除术中镇痛程度的临床价值.方法择期行胸腔镜肺叶切除术患者40例,ASA分级Ⅰ或Ⅱ级,年龄25～64岁,体重45～80 kg.异丙酚、舒芬太尼、顺阿曲库铵诱导后插入双腔气管导管,异丙酚、瑞芬太尼和顺阿曲库铵维持麻醉.于体位转换、单双肺通气模式转换、切皮及胸腔镜套管置入、清扫淋巴结及胸腔冲洗各操作前、后(5 min内)记录ANI、HR、SBP、DBP、BIS值的极值.于切皮及胸腔镜套管置入、清理淋巴结脂肪组织及胸腔冲洗期间记录血流动力学反应(HR和SBP波动幅度高于基础值20％)的发生情况.结果切皮及胸腔镜套管置入时血流动力学反应发生率100％,清扫纵膈第4、7、10组淋巴结以及胸腔冲洗后血流动力学反应发生率84％.与操作前比较,切皮及胸腔镜套管置入、清扫纵膈第4、7、10组淋巴结以及胸腔冲洗后5 min内ANI明显降低(P＜0.05).术中维持BIS值40～60,操作前后比较差异无统计学意义(P＞0.05).平、侧卧位及单、双肺通气模式转换前后ANI、HR、SBP、DBP比较差异无统计学意义(P＞0.05).结论 ANI可用于患者胸腔镜肺叶切除术中镇痛程度的评估,不受术中体位和通气模式转换的影响.
목적 초보탐토진통/상해성자격지수(ANI)평고흉강경폐협절제술중진통정도적림상개치.방법 택기행흉강경폐협절제술환자40례,ASA분급Ⅰ혹Ⅱ급,년령25～64세,체중45～80 kg.이병분、서분태니、순아곡고안유도후삽입쌍강기관도관,이병분、서분태니화순아곡고안유지마취.우체위전환、단쌍폐통기모식전환、절피급흉강경투관치입、청소림파결급흉강충세각조작전、후(5 min내)기록ANI、HR、SBP、DBP、BIS치적겁치.우절피급흉강경투관치입、청리림파결지방조직급흉강충세기간기록혈류동역학반응(HR화SBP파동폭도고우기출치20％)적발생정황.결과 절피급흉강경투관치입시혈류동역학반응발생솔100％,청소종격제4、7、10조림파결이급흉강충세후혈류동역학반응발생솔84％.여조작전비교,절피급흉강경투관치입、청소종격제4、7、10조림파결이급흉강충세후5 min내ANI명현강저(P＜0.05).술중유지BIS치40～60,조작전후비교차이무통계학의의(P＞0.05).평、측와위급단、쌍폐통기모식전환전후ANI、HR、SBP、DBP비교차이무통계학의의(P＞0.05).결론 ANI가용우환자흉강경폐협절제술중진통정도적평고,불수술중체위화통기모식전환적영향.
Objective To primarily investigate the clinical value of analgesia/nociception index (ANI) in evaluating the analgesic effect during lobectomy performed via video-assisted thoracoscope.Methods Forty ASA physical status Ⅰ or Ⅱ patients,aged 25-64 yr,weighing 45-80 kg,undergoing elective lobectomy performed via video-assisted thoracoscope,were enrolled in this study.After induction of anesthesia with propofol,sufentanil and cisatracurium,patients received double lumen endotracheal intubation.Anesthesia was maintained with targetcontrolled infusion of propofol,and iv infusion of remifentanil and cisatracurium.The concentration of propofol was adjusted to maintain the bispectral index (BIS) value in the range of 40-60.ANI,HR,systolic blood pressure (SBP),diastolic blood pressure (DBP) and BIS value were recorded within 5 min before and after the predefined time points including posture change between lateral and supine position,ventilatory pattern change between onelung and double-lung ventilation,skin incision and trocars insertion,lymph node dissection and pleural lavage.At skin incision and during trocars insertion,lymph node dissection and pleural lavage,the development of hemodynamic responses (increase in HR and SBP ＞ 20％ of baseline value) were recorded.Results The incidence of hemodynamic responses was 100％ at skin incision and trocars insertion,and 84 ％ during No.4,7,10 groups of lymph node dissection and after pleural lavage and difference was found in ANI during these stimuli.ANI was significantly decreased within 5 min after skin incision,trocars insertion,No.4,7,10 groups of lymph node dissection and pleural lavage than that before the procedures (P ＜ 0.05).The BIS value was maintained at 40-60,and no significant changes were found between before and after the procedures (P ＞ 0.05).No significant changes were found in ANI,HR,SBP,and DBP between before and after the changes of posture and respiratory pattern (P ＞ 0.05).Conclusion ANI can be used to evaluate the analgesic effect during lobectomy performed via video-assisted thoracoscope in patients and is unaffected by the changes of posture and ventilatory pattern.