术中伤害性刺激后瑞芬太尼增量剂量与伤害感受水平（NOL）指数反应的相关性。
Correlation between incremental remifentanil doses and the Nociception Level (NOL) index response after intraoperative noxious stimuli.
机构信息
Department of Anesthesiology of Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montreal, University of Montreal, 5415 Boulevard de l'Assomption, Montreal, QC, H1T 2M4, Canada.
Department of Surgery, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montreal, University of Montreal, Montreal, QC, Canada.
出版信息
Can J Anaesth. 2019 Sep;66(9):1049-1061. doi: 10.1007/s12630-019-01372-1. Epub 2019 Apr 17.
BACKGROUND
The Pain Monitoring Device (PMD) monitor (Medasense Biometrics Ltd., Ramat Gan, Israel) uses the Nociception Level (NOL) index, a multiple parameter-derived index that has recently shown a good sensitivity and specificity to detect noxious stimuli. The aim of this study was to assess the latest version of the device (PMD200) on variations of the NOL response after standardized tetanic stimuli to study the correlation between remifentanil doses and NOL.
METHODS
Data from 26 patients undergoing midline laparotomy and receiving a desflurane-remifentanil-based anesthetic coupled with low thoracic epidural analgesia were analyzed. A standardized tetanic stimulus was applied to the forearm of the patients at different remifentanil infusion rates. The primary aim was to evaluate the correlation between post-tetanic stimulation NOL values from the PMD200 and remifentanil doses. The NOL index variations after experimental and clinical stimuli were also compared with heart rate (HR), mean arterial pressure (MAP), and Bispectral Index™ (BIS).
RESULTS
A correlation between post-tetanic stimulation NOL values and remifentanil doses was found (r = -0.56; 95% confidence interval [CI], -0.70 to -0.44; P < 0.001). The NOL discriminated noxious from non-noxious states with the maximal Youden's index value of the NOL receiver operating characteristic (ROC) curve showing a specificity of 88% (95% CI, 69.0 to 100) and sensitivity of 79.1% (95% CI, 56.2 to 95.5). The area under the NOL ROC curve (AUC, 0.9; 95% CI, 0.84 to 0.95) was significantly different from the other variables (P < 0.001 vs HR; P < 0.001 vs MAP; P < 0.001 vs BIS).
CONCLUSIONS
The NOL value after noxious stimulus decreased with incremental remifentanil doses, showing a significant inverse correlation between the NOL index and opioid doses. The sensitivity and specificity of NOL to discriminate between noxious and non-noxious stimuli suggests its interesting potential as a monitor of nociception intensity during anesthesia.
TRIAL REGISTRATION
www.clinicaltrials.gov (NCT02884778); 27 July, 2016.
背景
疼痛监测器（PMD）监测仪（Medasense Biometrics Ltd.，Ramat Gan，以色列）使用伤害感受水平（NOL）指数，这是一种最近显示出良好的敏感性和特异性的多参数衍生指数，用于检测有害刺激。本研究的目的是评估最新版本的设备（PMD200）在标准化强直刺激后 NOL 反应的变化，以研究瑞芬太尼剂量与 NOL 之间的相关性。
方法
分析了 26 名接受地氟醚-瑞芬太尼为基础的麻醉和低胸段硬膜外镇痛的中线剖腹手术患者的数据。在不同瑞芬太尼输注率下对患者的前臂施加标准化强直刺激。主要目的是评估 PMD200 强直后刺激 NOL 值与瑞芬太尼剂量之间的相关性。还比较了实验和临床刺激后的 NOL 指数变化与心率（HR）、平均动脉压（MAP）和脑电双频指数（BIS）。
结果
发现强直后刺激 NOL 值与瑞芬太尼剂量之间存在相关性（r = -0.56；95%置信区间 [CI]，-0.70 至 -0.44；P < 0.001）。NOL 可以区分有害和无害状态，NOL 接收器操作特征（ROC）曲线的最大 Youden 指数值显示特异性为 88%（95%CI，69.0 至 100），敏感性为 79.1%（95%CI，56.2 至 95.5）。NOL ROC 曲线下面积（AUC，0.9；95%CI，0.84 至 0.95）与其他变量显著不同（P < 0.001 与 HR；P < 0.001 与 MAP；P < 0.001 与 BIS）。
结论
有害刺激后的 NOL 值随着瑞芬太尼剂量的增加而降低，NOL 指数与阿片类药物剂量之间存在显著的反比关系。NOL 区分有害和无害刺激的敏感性和特异性表明，它作为麻醉期间伤害感受强度监测器具有潜在的有趣性。
试验注册
www.clinicaltrials.gov（NCT02884778）；2016 年 7 月 27 日。
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