【罂粟摘要】术前焦虑和痛觉敏感在超声内镜检查中对术前血流动力学、丙泊酚消耗量、术后恢复及疼痛的影响
术前焦虑和痛觉敏感在超声内镜检查中对术前血流动力学、丙泊酚消耗量、术后恢复及疼痛的影响
贵州医科大学 高鸿教授课题组
翻译：胡廷菊 编辑：佟睿 审校：曹莹
本研究探讨了术前焦虑和疼痛敏感对麻醉药的消耗，达到理想的镇静水平所需要的时间，术前血流动力学，术后恢复时间和术后疼痛等的影响。
本研究纳入80例ASA I-II级病人，年龄20到65岁之间，择期在镇静麻醉下行超声内镜检查。所有病人术前在指导下填写Spielberger状态-特性焦虑量表（STAI）和疼痛敏感性问卷（PSQ）。镇静方法为：静脉注射咪达唑仑0.03mg/kg，利多卡因1mg/kg，芬太尼1μg/kg，丙泊酚1mg/kg注射时间大于60秒。记录双频指数达到75需要的时间。以丙泊酚2mg/kg/h输注进行麻醉维持。为了防止镇静失败，单次追加丙泊酚0.1mg/kg以维持BIS在65-75之间。当BIS降到65以下时，停止输注丙泊酚。
焦虑状态（Stai-S）和焦虑特性（Stai-T）评分与PSQ轻微疼痛和PSQ总分呈显著正相关，达到BIS 75需要的时间，镇静需要的丙泊酚剂量，丙泊酚追加剂量，心率，术后恢复室时长与术前焦虑和疼痛显著正相关。在术后疼痛方面，1h时的视觉模拟量表(VAS)与Stai-S和Stai-T的相关性高于PSQ。术后2h的VAS仅与Stai-S和Stai-T相关。
结论
术前焦虑和疼痛敏感性与麻醉药需求之间存在显著线性相关，可以通过预测个体麻醉药消耗量来促进更好的术前管理。
Ferda Yilmaz Inal，Yadigar Yilmaz Camgoz，Hayrettin Daskaya，et al.The Effect of Preoperative Anxiety and Pain Sensitivity on Preoperative Hemodynamics, Propofol Consumption, and Postoperative Recovery and Pain in Endoscopic Ultrasonography.[J]Pain and Therapy.2021 Jul 22.doi: 10.1007/s40122-021-00292-7.
The Effect of Preoperative Anxiety and Pain Sensitivity on Preoperative Hemodynamics, Propofol Consumption, and Postoperative Recovery and Pain in Endoscopic Ultrasonography
Abstract
Background: The present study investigates how preoperative anxiety and pain sensitivity affect the consumption of anesthetics, time elapsed until the desired sedation level is achieved, preoperative hemodynamics, postoperative recovery time, and postoperative pain.
Method:The present study includes 80 ASA 1–2 patients aged between 20 and 65 who were scheduled for endoscopic ultrasonography (EUS) under sedation. Patients were instructed to fill out the Spielberger State-Trait Anxiety Inventory (STAI) and Pain Sensitivity Questionnaire (PSQ) before the procedure. For sedation, 0.03 mg kg-1 intravenous midazolam, 1 mg kg-1 lidocaine, 1 l kg-1 fentanyl, and then a bolus dose of 1 mg kg-1 propofol were infused over a period of 60 s. The time elapsed until the bispectral index (BIS) value reached 75 was recorded. For anesthesia maintenance, 2 mg kg-1 h-1 propofol infusion was administered. In the case of sedation failure, an additional dose of 0.1 mg kg-1 propofol (IV) was administered to ensure sedation depth with a BIS level of 65–75, and the propofol infusion was halted once the BIS value dropped below 65.
Results:STAI-S and STAI-T scores were significantly positively correlated with PSQ minor pain and PSQ total scores. The time elapsed until reaching a BIS level of 75, propofol infusion dose used during sedation, and the need for additional doses of propofol, heart rate (HR), and duration of post-anesthesia care unit stay were significantly positively correlated with both preoperative anxiety and preoperative pain sensitivity. In terms of postoperative pain, the visual analog scale (VAS) at 1 h was more highly correlated with STAI-S and STAI-T than with PSQ. The VAS 2 h was only correlated with STAI-S and STAI-T.
Conclusion:The significant linear correlation between preoperative anxiety and pain sensitivity and anesthesia need can facilitate better preoperative management by predicting individual anesthetic consumption.