Bergman Tommi, Kalliomäki Maija-Liisa, Särkelä Mika, Harju Jarkko
Tampere University Hospital, Tampere, Finland.
GE Healthcare Finland Oy, Helsinki, Finland.
J Clin Monit Comput. 2025 Jan 20. doi: 10.1007/s10877-025-01262-6.
The measurement of nociception and the optimisation of intraoperative antinociceptive medication could potentially improve the conduct of anaesthesia, especially in the older population. The Surgical Pleth Index (SPI) is one of the monitoring methods presently used for the detection of nociceptive stimulus. Eighty patients aged 50 years and older who were scheduled to undergo major abdominal surgery were randomised and divided into a study group and a control group. In the study group, the SPI was used to guide the administration of remifentanil during surgery. In the control group, the SPI value was concealed, and remifentanil administration was based on the clinical evaluation of the attending anaesthesiologist. The primary endpoint of this study was intraoperative remifentanil consumption. In addition, we compared the durations of intraoperative hypotension and hypertension. No difference in intraoperative remifentanil consumption (4.5 µg kgh vs. 5.6 µg kgh, p = 0.14) was found. Furthermore, there was no difference in the proportion of hypotensive time (mean arterial pressure, MAP < 65) (3.7% vs. 1.6%, p = 0.40). However, in the subgroup of patients who underwent operation with invasive blood pressure monitoring, there was less severe hypotension (MAP < 55) (0.3% vs. 0.0%, p = 0.02) and intermediate hypotension (MAP < 65) (10.2% vs. 2.6%, p = 0.07) in the treatment group, even though remifentanil consumption was higher (3.5 µg kgh vs. 5.1 µg kghp = 0.03). The use of SPI guidance for the administration of remifentanil during surgery did not help to reduce the remifentanil consumption. However, the results from invasively monitored study group suggest more timely administered opioid when SPI was used.
伤害感受的测量以及术中抗伤害性药物的优化使用可能会改善麻醉过程，尤其是在老年人群中。外科容积指数（SPI）是目前用于检测伤害性刺激的监测方法之一。80例年龄在50岁及以上、计划接受腹部大手术的患者被随机分为研究组和对照组。研究组在手术期间使用SPI指导瑞芬太尼的给药。对照组则对SPI值进行保密，瑞芬太尼的给药基于主治麻醉医生的临床评估。本研究的主要终点是术中瑞芬太尼的消耗量。此外，我们比较了术中低血压和高血压的持续时间。结果发现，术中瑞芬太尼消耗量并无差异（4.5微克/千克·小时 vs. 5.6微克/千克·小时，p = 0.14）。此外，低血压时间（平均动脉压，MAP < 65）的比例也没有差异（3.7% vs. 1.6%，p = 0.40）。然而，在接受有创血压监测手术的患者亚组中，治疗组的严重低血压（MAP < 55）（0.3% vs. 0.0%，p = 0.02）和中度低血压（MAP < 65）（10.2% vs. 2.6%，p = 0.07）情况较少，尽管瑞芬太尼消耗量更高（3.5微克/千克·小时 vs. 5.1微克/千克·小时，p = 0.03）。手术期间使用SPI指导瑞芬太尼给药无助于减少瑞芬太尼的消耗量。然而，有创监测研究组的结果表明，使用SPI时阿片类药物给药更及时。
