From the Department of Anaesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo (HO, TO, RU, NK, TT, MH), the Department of Anaesthesiology & Reanimatology, Faculty of Medicine Sciences, University of Fukui, Eiheiji-cho, Fukui, Japan (YM, KS).
Eur J Anaesthesiol. 2021 Dec 1;38(12):1215-1222. doi: 10.1097/EJA.0000000000001505.
Surgical procedures stimulate nociception and induce physiological responses according to the balance between nociception and antinociception. The severity of surgical stimuli is associated with major postoperative complications. Although an intra-operative quantitative index representing surgical invasiveness would be useful for anaesthetic management to predict and prevent major complications, no such index is available.
To identify associations between major complications after gastrointestinal surgery and intra-operative quantitative values from intra-operative nociception monitoring.
A multi-institutional observational study.
Two university hospitals.
Consecutive adult patients undergoing gastrointestinal surgery under general anaesthesia.
Averaged values of nociceptive response index from start to end of surgery (mean NR index) and risk scores of the Surgical Mortality Probability Model (S-MPM) were calculated. Pre and postoperative serum C-reactive protein (CRP) levels were obtained. After receiver-operating characteristic (ROC) curve analysis, all patients were divided into groups with high and low mean nociceptive response index. Associations between mean nociceptive response index and postoperative major complications, defined as Clavien-Dindo grade at least IIIa, were examined using logistic regression analysis.
ROC curve analysis showed a nociceptive response index cut-off value for major complications of 0.83, and we divided patients into two groups with mean nociceptive response index less than 0.83 and at least 0.83. The incidence of major complications was significantly higher in patients with mean nociceptive response index at least 0.83 (23.1%; n = 346) than in patients with mean nociceptive response index less than 0.83 (7.7%; n = 443; P < 0.001). Multivariate analysis revealed emergency surgery, S-MPM risk score, mean nociceptive response index and postoperative CRP levels as independent risk factors for major complications.
Mean nociceptive response index during surgery likely correlates with major complications after gastrointestinal surgery.
The current observational study had no intervention, and was therefore, not registered.
手术刺激会引发伤害感受，并根据伤害感受和抗伤害感受之间的平衡引起生理反应。手术刺激的严重程度与主要术后并发症有关。虽然术中定量指标代表手术侵袭性对于麻醉管理以预测和预防主要并发症很有用，但目前还没有这样的指标。
确定胃肠手术后主要并发症与术中伤害感受监测的术中定量值之间的关联。
多机构观察性研究。
两所大学医院。
全身麻醉下接受胃肠手术的连续成年患者。
从手术开始到结束时的伤害感受反应指数平均值（平均 NR 指数）和外科死亡率概率模型（S-MPM）的风险评分。术前和术后血清 C 反应蛋白（CRP）水平。在接受者操作特征（ROC）曲线分析后，所有患者均根据高和低平均伤害感受反应指数分为两组。使用逻辑回归分析检查平均伤害感受反应指数与术后主要并发症（定义为 Clavien-Dindo 分级至少 IIIa 级）之间的关联。
ROC 曲线分析显示，主要并发症的伤害感受反应指数截断值为 0.83，我们将患者分为平均伤害感受反应指数小于 0.83 和至少 0.83 的两组。平均伤害感受反应指数至少为 0.83 的患者（23.1%；n=346）主要并发症的发生率明显高于平均伤害感受反应指数小于 0.83 的患者（7.7%；n=443；P<0.001）。多变量分析显示，急诊手术、S-MPM 风险评分、平均伤害感受反应指数和术后 CRP 水平是主要并发症的独立危险因素。
手术过程中的平均伤害感受反应指数可能与胃肠手术后的主要并发症相关。
本观察性研究没有干预，因此没有注册。
