Xing Liji, Xie Hong, Zhou Xuelan, Zhu Jiang, Liu Hairui
Department of Anesthesiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Med Sci Monit. 2025 Jun 23;31:e948209. doi: 10.12659/MSM.948209.
BACKGROUND Monitoring nociception is extraordinarily challenging during general anesthesia. This study aimed to observe pupillary dilation reflex by ultrasound and determine whether ultrasonic pupillary parameters are correlated with sufentanil dose during the induction period of general anesthesia. MATERIAL AND METHODS We enrolled 93 patients undergoing general anesthesia. They were randomly divided into 3 groups - group P (saline), group S1 (0.2 μg/kg sufentanil), and group S2 (0.4 μg/kg sufentanil) - according to the sufentanil dose of induction. Patients were administered a tetanic stimulation 5 min after intravenous injection with sufentanil. Ultrasonic pupil diameters were recorded and measured at 4 time points: T0 (entering the room awake), T1 (after loss of consciousness), T2 (5 min after intravenous injection with sufentanil), and T3 (the moment at which pupil diameter was maximum after stimulation). Systolic blood pressure, diastolic blood pressure, heart rate, and BIS at T0~T3 were recorded. The process of pupillary dilation reflex was recorded in ultrasound views and videos to generate relevant clinical data, including pupillary dilation reflex amplitude, pupillary dilation reflex rate, whether pupillary dilation reflex was inhibited, pupillary dilation reflex latency, and pupillary dilation reflex duration. RESULTS Ultrasonic pupillary dilation reflex amplitude and pupillary dilation reflex rate were negatively correlated with sufentanil dose [Spearman r=-0.84 (95% CI, -0.88 to -0.77), p<0.01, Spearman r=-0.74, (95% CI, -0.82 to -0.64), p<0.01]. Only PD responded to stimulation within 30 s, whereas systolic blood pressure, diastolic blood pressure, and BIS did not respond to stimulation. CONCLUSIONS Ultrasound can be a useful method for observing pupillary dilation reflex, and sufentanil inhibits pupillary dilation reflex in a dose-dependent manner. Ultrasonic pupillary dilation reflex is sensitive to noxious stimulation.
背景 在全身麻醉期间监测伤害感受极具挑战性。本研究旨在通过超声观察瞳孔扩张反射，并确定在全身麻醉诱导期超声瞳孔参数是否与舒芬太尼剂量相关。
材料与方法 我们纳入了93例接受全身麻醉的患者。根据诱导时舒芬太尼的剂量，将他们随机分为3组——P组（生理盐水）、S1组（0.2μg/kg舒芬太尼）和S2组（0.4μg/kg舒芬太尼）。患者在静脉注射舒芬太尼5分钟后接受强直刺激。在4个时间点记录并测量超声瞳孔直径：T0（清醒入室时）、T1（意识消失后）、T2（静脉注射舒芬太尼5分钟后）和T3（刺激后瞳孔直径最大的时刻）。记录T0至T3时的收缩压、舒张压、心率和脑电双频指数（BIS）。在超声视图和视频中记录瞳孔扩张反射过程，以生成相关临床数据，包括瞳孔扩张反射幅度、瞳孔扩张反射率、瞳孔扩张反射是否受抑制、瞳孔扩张反射潜伏期和瞳孔扩张反射持续时间。
结果 超声瞳孔扩张反射幅度和瞳孔扩张反射率与舒芬太尼剂量呈负相关[Spearman相关系数r = -0.84（95%CI，-0.88至-0.77），p < 0.01；Spearman相关系数r = -0.74，（95%CI，-0.82至-0.64），p < 0.01]。仅瞳孔直径（PD）在30秒内对刺激有反应，而收缩压、舒张压和BIS对刺激无反应。
结论 超声可作为观察瞳孔扩张反射的有用方法，舒芬太尼以剂量依赖方式抑制瞳孔扩张反射。超声瞳孔扩张反射对有害刺激敏感。
