健康志愿者清醒时疼痛程度与镇痛伤害感受指数相关性研究

Analgesia Nociception Index: a cross-over study to evaluate a new parameter for objective assessment of pain in conscious healthy volunteers

摘要:

目的 VAS是评价疼痛的金标准，但对于无法自评的患者（麻醉状态、意识障碍等），VAS的应用便有所限制。另外VAS评分很难区分心因痛和躯体痛。镇痛伤害感受指数ANI，其基于心率变异性，从而反应交感/副交感平衡，可用于判断全麻患者的镇痛深度。本研究目的在于探讨镇痛伤害感受指数ANI是否可用于清醒受试者急性疼痛的客观评价，研究ANI与VAS的相关性。 方法 本试验为预实验，受试者共40人，采用随机双盲交叉对照试验，用冷痛模型对受试者右前臂尺侧皮肤进行冷痛刺激，记录疼痛时ANI与VAS数值。采用SPSS 13.0统计学软件进行统计学分析，计量资料以均数±标准差(x±s)表示，组间比较采用t检验。ANI与 VAS间进行pearson相关分析。结果 在健康受试者中ANI与VAS存在一定程度的负相关，相关系数为-0.267。结论 尽管ANI与VAS存在一定的负相关，但目前ANI并不能取代VAS准确评估疼痛程度。

Abstract:

Objective To explore the correlation between Analgesia Nociception Index (ANI) and Visual Analogue Scale (VAS) in conscious healthy volunteers and the possibility of using ANI for objective pain assessment. Methods: Forty healthy volunteers were enrolled in this Randomized, double-blind, cross-over trial. The cold pressor model(0.1℃,60 seconds) was used to stimulate the volunteers in the forearm skin. Record their ANI and VAS data immediately when the pain stimulation was over. SPSS 13.0 statistical software was used for statistical analysis. The data was expressed as mean ± standard deviation (x ± s).The t-test was used for comparison between groups. Pearson correlation analysis was conducted for ANI and VAS. A receiver-operating characteristic(ROC) curve was used to evaluate the performance of ANI to predict VAS>30. Results: There is a small but statistically significant negative correlation between ANI and VAS. The correlation efficient is -0.267. The receiver-operating analysis testing ANI value for predicting VAS>30 revealed only low sensitivity and specificity, corresponding to an area under the ROC curve of 0.603. Conclusion: ANI cannot replace VAS to accurately assess pain intensity despite the negative correlation between ANI and VAS.