Li Hua, Tang Yingying, Chen Xiaoping, Zhang Mengge, Jiang Feng, Zhu Fangfang, Xie Linghua, Wu Hui, Xu Qi, Chen Qing, Xie Shulan, Dai Ange, Chen Xinzhong
Department of Anesthesia, The third people's hospital of Hefei，Hefei Third Clinical College, Anhui Medical University, Hefei, China.
Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
BMC Anesthesiol. 2025 Feb 17;25(1):78. doi: 10.1186/s12871-025-02932-3.
Validated monitoring methods for evaluating the balance of nociception and anti-nociception (BNAN) are needed in general anesthesia. This study assessed six photoplethysmography (PPG) parameters, computed from finger photoplethysmographic waveforms in patients undergoing gynecological surgery under general anesthesia.
A total of 20 participants were included, each undergoing general anesthesia with propofol and remifentanil. The same concentration of remifentanil was maintained throughout the experiment, four different intensities of electrical stimulation were administered, and the patient's fingertip PPG was meticulously recorded. PPG data were preprocessed to extract six PPG morphological parameters, and photoplethysmographic amplitude (PPGA), pulse beat interval (PBI), and surgical pleth index (SPI). Receiver operating characteristic (ROC) curves and the Area Under the Curve (AUC) were constructed and calculated to accurately measure its ability to reflect the nociceptive stimulus state. The consistency of different phase parameters at different stimulus intensities was evaluated by calculating the prediction probabilities. All results were compared with those obtained using SPI, PPGA, and PBI.
After stimulation, all parameters and SPI showed significant changes compared with those before stimulation (p = 0.000). The catacrotic phase parameters (AC and MHC) showed higher discrimination in adequate analgesia and congruence with electrical stimulation intensity than the overall phase parameters, PPGA, and anacrotic phase parameters (AC: AUC = 0.851, Pk = 0.800; MHC: AUC = 0.837, Pk = 0.792).
In this study, six PPG morphological parameters were proposed and observed for the first time to effectively distinguish the occurrence of nociception. Compared with the overall phase parameters, PPGA, and anacrotic phase parameters, catacrotic phase parameters were more capable of characterizing noxious stimuli and more consistent with changes in electrical stimulation intensity.
ChiCTR2200062228; Registered at http://clinicaltrials.gov on July 30, 2022.
全身麻醉中需要有效的监测方法来评估伤害感受与抗伤害感受的平衡（BNAN）。本研究评估了六个从全身麻醉下接受妇科手术患者的手指光电容积脉搏波描记图波形计算得出的光电容积脉搏波描记法（PPG）参数。
共纳入20名参与者，每名参与者均接受丙泊酚和瑞芬太尼全身麻醉。在整个实验过程中维持相同浓度的瑞芬太尼，施加四种不同强度的电刺激，并精心记录患者指尖的PPG。对PPG数据进行预处理以提取六个PPG形态学参数，即光电容积脉搏波幅值（PPGA）、脉搏搏动间隔（PBI）和手术容积指数（SPI）。构建并计算受试者工作特征（ROC）曲线和曲线下面积（AUC），以准确测量其反映伤害性刺激状态的能力。通过计算预测概率来评估不同刺激强度下不同相位参数的一致性。所有结果均与使用SPI、PPGA和PBI获得的结果进行比较。
刺激后，所有参数和SPI与刺激前相比均有显著变化（p = 0.000）。降中峡相位参数（AC和MHC）在充分镇痛方面显示出比整体相位参数、PPGA和升中峡相位参数更高的辨别力，且与电刺激强度一致（AC：AUC = 0.851，Pk = 0.800；MHC：AUC = 0.837，Pk = 0.792）。
在本研究中，首次提出并观察到六个PPG形态学参数可有效区分伤害感受的发生。与整体相位参数、PPGA和升中峡相位参数相比，降中峡相位参数更能表征有害刺激，且与电刺激强度变化更一致。
ChiCTR2200062228；于2022年7月30日在http://clinicaltrials.gov注册。
