重症监护中的疼痛监测:痛觉水平指数对治疗和预后有何影响?随机对照双盲试验。

Berna Çalışkan, Zeki Besir, Oznur Sen
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引用次数: 0

摘要

背景:有效的疼痛管理在重症监护环境中至关重要,尤其是在手术后。临床医生应保持客观、高效的标准,以患者为中心评估疼痛,从而有效管理这一复杂问题。一项较新的技术--痛觉水平(NOL)指数通过多参数评估,有望实现这一任务:本研究是一项前瞻性、对照、随机试验,涉及两组不同重症监护病房的患者(每组 30 人)。参与者年龄均在 18 岁以上,美国麻醉学会评分为 I 至 III 级,并计划在全身麻醉后接受重症监护随访。所有受试者都遵循标准镇痛方案,包括抢救性镇痛。对照组通过数字评分表和重症监护疼痛观察工具指导用药,而 NOL 组则通过痛觉水平指数监测指导用药:结果:两组患者的疼痛评分无明显差异。结果:两组患者的疼痛评分无明显差异,但在 NOL 组中,疼痛评分与痛觉值呈很强的正相关性。值得注意的是,NOL 组的镇痛药总用量明显较低(P=0.036):结论:与重症监护中使用的标准疼痛评分相比,使用痛觉水平指数监测疼痛是一种有效的疼痛检测方法。其指导作用有助于个性化镇痛剂滴定。此外,痛觉水平指数指导缩短重症监护和住院时间的潜力可能与其对谵妄的影响有关,这一联系有待未来研究的进一步探索。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pain monitoring in intensive care: How does the nociception level index affect treatment and prognosis? A randomized, controlled, double-blind trial.

Background: Effective pain management is vital in critical care settings, particularly post-surgery. Clinicians should maintain objective and efficient standards to assess pain in a patient-centered manner, in order to effectively manage this complex issue. A newer technology, the nociception level (NOL) index, shows promise in achieving this task through its multi-parameter evaluation.

Methods: This study was a prospective, controlled, randomized trial involving two groups of patients (n=30 each) in a diverse intensive care unit. Participants were over 18 years old with American Society of Anesthesiology scores ranging from I to III and were scheduled for critical care follow-up after general anesthesia. All subjects followed a standard analgesia protocol that included rescue analgesia. Drug administration was guided by a numeric rating scale and the critical care pain observation tool in the Control Group, while it was guided by nociception level index monitoring in the NOL Group.

Results: Pain scores between the two groups did not significantly differ. However, within the NOL Group, pain scores and noci-ception values displayed a strong positive correlation. Notably, total analgesic consumption was significantly lower in the NOL Group (p=0.036).

Conclusion: Monitoring pain using the nociception level index is an effective method for detecting pain compared to standard pain scores utilized in critical care. Its guidance facilitates personalized analgesic titration. Additionally, the potential of nociception level index guidance to reduce the duration of intensive care and hospital stays may be linked to its effects on delirium, a connection that awaits further exploration in future studies.

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