心率变异性镇痛伤害感受指数在小儿七氟醚麻醉中的预测价值：观察试验研究
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The predictive value of the heart-rate-variability derived Analgesia Nociception Index in children anaesthetised with sevoflurane - an observational pilot-study
背景与目的
心率变异性（HRV）镇痛伤害感受指数（ANI）是评估无意识患者的伤害感受/抗伤害感受平衡的连续非侵入性指标。研究表明其在检测儿童抗伤害感受不足上优于血液动力学变量，但其预测价值却少有文献报道。
方 法
本前瞻性观察试验研究的主要目的是通过对七氟醚麻醉下儿科手术患者ANI和心率预测值的比较以决定是否需要给予阿片类药物。负责儿科的麻醉医生对ANI值不知情。
结 果
对于ANI值<50（指示抗伤害感受不足）的患者，在决定给予阿片类药物60s之前，ANI值从±55（表明足够的抗伤害感受）下降到±35。在120s内，给予芬太尼（1 mcg/kg）后，ANI值恢复至±60。且该现象仅在平均超过2min且源自HRV的 ANI值中观察到，而心率保持不变。对于ANI值≥50的患者，给予阿片类药物对ANI值或心率没有影响。吗啡用于手术后镇痛和术中使用芬太尼时的情况相同。
结 论
本研究证明了在检测七氟醚麻醉下小儿外科手术患者的抗伤害感受不足方面ANI比心率有更好的预测价值。且给予阿片类药物后可重建足够的抗伤害感受性。
原始文献摘要
Frank Weber 1, Noortje J.E. Geerts 1, Hilde G. Roeleveld ，et al. The predictive value of the heart-rate-variability derived Analgesia Nociception Index in children anaesthetised with sevoflurane - an observational pilot-study.[J]Eur J Pain. 2018 May 13. doi: 10.1002/ejp.1242.
BACKGROUND:
The heart rate variability (HRV) derived Analgesia Nociception Index (ANI™ ) is a continuous non-invasive tool to assess the nociception/anti-nociception balance in unconscious patients. It has been shown to be superior to hemodynamic variables in detecting insufficient anti-nociception in children, while little is known about its predictive value.
METHODS:
The primary objective of this prospective observational pilot study in paediatric surgical patients under sevofluraneanaesthesia, was to compare the predictive value of the ANI and heart rate to help decide to give additional opioids. The paediatric anaesthesiologist in charge was blinded to ANI values.
RESULTS:
In patients with an ANI value <50 (indicating insufficient anti-nociception) at the moment of decision, ANI values dropped from ±55 (indicating sufficient anti-nociception) to ±35, starting 60 sec. before decision. Within 120 sec. after administration of fentanyl (1 mcg/kg), ANI values returned to ±60. This phenomenon was only observed in the ANI values derived from HRV data averaged over 2 min. Heart rate remained unchanged. In patients with ANI values ≥50 at the time of decision, opioid administration had no effect on ANI or heart rate. The same accounts for morphine for postoperative analgesia and fentanyl in case of intraoperative movement.
CONCLUSIONS:
This study provides evidence of a better predictive value of the ANI in detecting insufficient anti-nociception in paediatric surgical patients than heart rate. The same accounts for depicting re-establishment of sufficient anti-nociception after opioid drug administration.
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