使用心率变异性分析评估新生儿疼痛。

Newborn infant pain assessment using heart rate variability analysis.

机构信息

Pôle de Médecine Néonatale, Hôpital Jeanne de Flandre, CHRU de Lille, Avenue Eugène Avinée, Lille Cedex 59035, France.

出版信息

Clin J Pain. 2010 Nov-Dec;26(9):777-82. doi: 10.1097/ajp.0b013e3181ed1058.

DOI:10.1097/ajp.0b013e3181ed1058

PMID:20973153

Abstract

OBJECTIVES

Systems controlling cardiovascular function are closely coupled with the perception of pain. Heart rate variability (HRV) is a well-established noninvasive measure of cardiac autonomic control. We hypothesized that pain may alter HRV in the newborn infant and that HRV analysis could be used as an indicator of prolonged pain in the newborn infant.

METHODS

To test the hypothesis, we measured the magnitude of the heart rate high-frequency variations using an innovative High Frequency Variability Index (HFVI) in newborn infants at risk of postoperative pain. We investigated newborn infants with a gestational age (GA) more than 34 weeks, and who were admitted after a major surgical procedure. Inclusions ranged from 2 to 72 hours after the surgery. The postoperative pain was scored using EDIN scale (neonatal pain and discomfort scale) at the end of the 2 hours recording period. The infants were separated in: (1) Group "Low EDIN," when EDIN<5; and (2) Group "High EDIN," when EDIN >=5. Predictive positive and negative values of a threshold value of HFVI in assessing pain have been studied.

RESULTS

Twenty-eight newborn infants were enrolled in the study (mean GA=37.8+/-1.5 wk) at a median delay between the surgery and the recording of 5 hours. Mean EDIN were 2+/-1 and 7+/-2 in respectively the groups "Low EDIN" and "High EDIN." The 2 groups were similar for GA, basal heart and respiratory rates, SpO2, mean arterial blood pressure, and morphine infusion rate. HFVI was significantly lower in the group "High EDIN" than in the group "Low EDIN" (0.7+/-0.2 vs. 1.2+/-0.3, respectively; P<0.01). An HFVI <0.9 was able to predict an EDIN score >=5, with a sensitivity of 90%, and a specificity of 75%.

DISCUSSION

The results of this study indicate that postoperative pain is associated with a decreased high-frequency HRV in full-term newborn infants. Our findings suggest that HRV could be used as an indicator to assess prolonged pain in the newborn infants.

摘要

目的

控制心血管功能的系统与疼痛感知密切相关。心率变异性（HRV）是一种成熟的心脏自主控制的非侵入性测量方法。我们假设疼痛可能会改变新生儿的 HRV，并且 HRV 分析可以用作新生儿长期疼痛的指标。

方法

为了验证这一假设，我们使用一种创新的高频变异性指数（HFVI）在有术后疼痛风险的新生儿中测量心率高频变化的幅度。我们研究了胎龄（GA）超过 34 周的新生儿，这些新生儿在进行重大手术后被收治。纳入范围从手术后 2 至 72 小时。在 2 小时记录期结束时，使用 EDIN 量表（新生儿疼痛和不适量表）对术后疼痛进行评分。将婴儿分为：（1）EDIN<5 时的“低 EDIN 组”；和（2）EDIN>=5 时的“高 EDIN 组”。研究了 HFVI 阈值评估疼痛的阳性和阴性预测值。

结果

28 名新生儿纳入研究（平均 GA=37.8+/-1.5 wk），手术与记录之间的中位数延迟为 5 小时。“低 EDIN”组和“高 EDIN”组的平均 EDIN 分别为 2+/-1 和 7+/-2。两组在 GA、基础心率和呼吸率、SpO2、平均动脉血压和吗啡输注率方面相似。“高 EDIN”组的 HFVI 明显低于“低 EDIN”组（分别为 0.7+/-0.2 与 1.2+/-0.3；P<0.01）。HFVI<0.9 能够预测 EDIN 评分>=5，灵敏度为 90%，特异性为 75%。