Analgesia nociception index for the assessment of pain in critically ill patients: a diagnostic accuracy study
Analgesia nociception index for the assessment of pain in critically ill patients: a diagnostic accuracy study
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DOI：
10.1093/bja/aex210
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发表时间：
2017-10-01
影响因子：
9.8
通讯作者：
Jaber, S.
中科院分区：
文献类型：
--
作者：
Chanques, G.;Tarri, T.;Jaber, S.
背景资料。行为疼痛工具用于重症监护病房(ICU)的患者，这些患者无法自我报告他们的疼痛强度，但由于这些临床工具的主观性质，需要持续努力来教育和培训ICU团队。本研究基于心率变异性的频谱分析，测量了一种电生理监测工具的有效性和性能，即痛觉伤害指数(ANI)，其范围从0(最小副交感张力，最大应激反应和疼痛)到100(最大副交感张力，最小应激反应和疼痛)。连续记录危重非昏迷患者常规护理前、中、后的ANI(ANIM)和ANI(ANII)，并与行为疼痛评定量表(BPS)进行比较。在110例患者中进行了969次评估。ANII是最有鉴别力的止痛工具。与BPS显著相关(r=-0.30；95%CI-0.37~-0.25；P=43，阴性预测值90%)。因此，在排除重大疼痛方面，ANII可能具有最高的益处。一项随机对照试验应将基于ANII的镇静止痛方案与目前推荐的行为止痛工具进行比较。
Background. Behavioural pain tools are used in Intensive Care Unit (ICU) patients unable to self-report their pain-intensity but need sustained efforts to educate and train the ICU team because of the subjective nature of these clinical tools. This study measured the validity and performance of an electrophysiological monitoring tool based on the spectral analysis of heart rate variability, the Analgesia Nociception Index (ANI) which varies from 0 (minimal parasympathetic tone, maximal stress-response and pain) to 100 (maximal parasympathetic tone, minimal stress-response and pain).Methods. Mean-ANI (ANIm) and Instant-ANI (ANIi) were continuously recorded then compared with the Behavioral Pain Scale (BPS) before, during and after routine care procedures in critically-ill non-comatose patients.Results. 969 assessments were performed in 110 patients. ANIi was the most discriminative pain tool. It was significantly correlated with BPS (r=-0.30; 95% CI-0.37 to -0.25; P= 43 had a Negative-Predictive-Value of 90%. Hence ANIi may be of highest benefit for excluding significant pain. A randomized controlled trial should compare sedation-analgesia protocols based on ANIi to presently recommended behavioural-pain-tools.