探討熱痛誘發下多種生理參數之反應

疼痛是每個人在成長過程中必定會經歷的感覺，它是個不愉快的生活經驗以及情緒上的感受，也是人們尋求醫療處置最常見的原因。臨床上因醫病溝通不良以及醫療人員短缺，使得大部分處於疼痛狀態下的病患無法獲得有效紓解。在2001年美國醫院評鑑機構將疼痛視為第五生命徵象且列入了醫院評鑑考核，並強調必須隨時隨地加以監測並記錄其變化。因此，如何有效連續監測和管理疼痛是為一課題。本研究將利用人為誘發疼痛的感覺，觀察多種與交感神經具有相關聯的生理參數如心電圖(ECG)、光體積變化描記圖(PPG)和膚電反應(GSR)，藉由連續觀察疼痛發生時生理參數的一系列變化，以及疼痛產生過程中，生理參數變化趨勢，試圖從這些客觀的生理訊號中找出與疼痛的關聯性，期望能促使臨床病患得到更好的疼痛管理品質。本研究臨床收案有效樣本共為35人(男性18位、女性17位)；其中實驗組25人(男性11位，女性14位)；對照組10人(男性7位，女性3位)，經統計分析得知，在模擬疼痛感受刺激後，數字疼痛量表(NRS)確實會產生顯著差異(P<0.05)。而心率變異度與光體積變化描記圖分析結果在刺激後確實會有所改變。推測當疼痛加劇時會促使交感神經興奮，並抑制副交感神經活性，導致心率上升以及高、低頻的改變。且當動脈壓力下降過低時，體內為調節平衡，壓力感受器會產生反射作用，促使血壓回復正常。期望藉由本研究得到的現象，經疼痛刺激下多種生理參數的變化，可以在將來應用於臨床中，以進一步透過非侵入式的方法來監測疼痛。

關鍵字

心率變異度；光體積變化描記圖；疼痛監測

並列摘要

Pain is a feeling that everyone experiences, and it can be an unpleasant and negative emotional experience. People sometimes seek medical treatment for the most common causes of pain. In clinical practice, a breakdown of doctor-patient communication and medical staff shortages can lead to unrelieved pain experienced by patients. In 2001, the Joint Commission Accreditation of Health Care Organization (JCAHO), which regards pain as fifth vital sign, and the inclusion of hospital accreditation item, has stressed the need for pain levels to be monitored at all times with any changes recorded. However, establishing effective continuous pain monitoring and management remains a challenge. In our research, we produced an induced heat pain stimulation and observed a variety of physiological parameters associated with the sympathetic nervous system such as Electrocardiography, Photoplethysmography and Galvanic skin response, with continuous observation of the changes in these physiological parameters when pain occurs. Through continuous monitoring, we aimed to determine a highly sensitive parameter that correlates with pain occurrence in order to improve the quality of clinical pain management. In this study, we included 35 effective samples in total, with 25 from the experimental group and 10 from the control group. After heat pain stimulation, statistical analysis showed that there were significant differences between the groups in the Numeric Rating Scale. Then, we found that heart rate variability and PPG were significantly different after heat pain stimulation. We hypothesize that the heat pain stimulus caused sympathetic nerve excitation and suppressed parasympathetic nerve activation while increasing the heart rate and high and low frequency changes occurred when the pain intensified. Additionally, when the arterial pressure dropped too low in vivo, the baroreceptor reflex regulated the equilibrium and promoted a return to normal blood pressure. According to the resultant phenomena of the experiment, multi physiological parameters would changed during heat stimulation. Clinicians may use this non-invasive technical to further monitor and evaluate the pain.

並列關鍵字

Heart rate variability ； Photoplethysmography ； Pain

參考文獻

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[3] R. C. Polomano, C. J. Dunwoody, D. A. Krenzischek, and J. P. Rathmell, “Perspective on pain management in the 21st century,” J Perianesth Nurs, vol. 23, no. 1 Suppl, pp. S4-14, Feb, 2008.

[4] K. S. Filos, and K. A. Lehmann, “Current concepts and practice in postoperative pain management: need for a change?,” Eur Surg Res, vol. 31, no. 2, pp. 97-107, 1999.

[5] J. L. Apfelbaum, C. Chen, S. S. Mehta, and T. J. Gan, “Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged,” Anesth Analg, vol. 97, no. 2, pp. 534-40, table of contents, Aug, 2003.

[6] D. M. Phillips, “JCAHO pain management standards are unveiled,” JAMA: the journal of the American Medical Association, vol. 284, no. 4, pp. 428-429, 2000.

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探討熱痛誘發下多種生理參數之反應

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