Storm Hanne
Faculty Division Rikshospitalet, Faculty of Medicine, Rikshospitalet University Hospital, and Medical Director, Med-Storm Innovation, Gimle terrasse 4, Oslo, Norway.
Curr Opin Anaesthesiol. 2008 Dec;21(6):796-804. doi: 10.1097/ACO.0b013e3283183fe4.
The skin conductance algesimeter (SCA) reflects the sympathetic nervous system influenced by changes in emotions, which releases the acetylcholine that acts on muscarine receptors, causing a subsequent burst of sweat and increased skin conductance. The SCA reacts immediately and is not influenced by hemodynamic variability or neuromuscular blockade. The use of SCA for pain and nociceptive assessment is outlined in this review.
When pain was monitored by verbal reporting in postoperative patients, the SCA had a sensitivity of about 90% and specificity up to 74% to identify the pain, better than heart rate and blood pressure. In general anesthetized patients, both the sensitivity and specificity were about 90% to detect responses to noxious stimulation when compared with clinical stress variables. The SCA reflects changes in norepeinephrine levels induced by nociception better than heart rate, blood pressure, and electroencephalograph (EEG) monitors. Unlike EEG monitors, the SCA response is sensitive to experimental noxious stimuli during general anesthesia, and the measured response was attenuated by analgesic medication. This SCA response is significantly associated with genetically modulated pain sensitivity. Moreover, noxious stimuli in artificially ventilated patients and in preterm infants increase the SCA index, and the increase correlates to the clinical discomfort.
The SCA detects nociceptive pain fast and continuously, specific to the individual, with higher sensitivity and specificity than other available objective methods.
皮肤电导痛觉计（SCA）反映受情绪变化影响的交感神经系统，该系统释放作用于毒蕈碱受体的乙酰胆碱，随后引发一阵出汗并增加皮肤电导。SCA反应迅速，不受血流动力学变化或神经肌肉阻滞的影响。本综述概述了SCA在疼痛和伤害性评估中的应用。
在术后患者中通过口头报告监测疼痛时，SCA识别疼痛的敏感性约为90%，特异性高达74%，优于心率和血压。在全身麻醉的患者中，与临床应激变量相比，检测对有害刺激的反应时，敏感性和特异性均约为90%。SCA比心率、血压和脑电图（EEG）监测器更能反映伤害性刺激引起的去甲肾上腺素水平变化。与EEG监测器不同，SCA反应在全身麻醉期间对实验性有害刺激敏感，且测量的反应会被镇痛药物减弱。这种SCA反应与基因调节的疼痛敏感性显著相关。此外，人工通气患者和早产儿中的有害刺激会增加SCA指数，且该增加与临床不适相关。
SCA能快速、持续地检测伤害性疼痛，具有个体特异性，比其他可用的客观方法具有更高的敏感性和特异性。
