患者术前痛阈和耐痛阈与气管插管和切皮诱发的应激反应强度的相关性

目的 探讨术前痛阈和耐痛阈与气管插管和切皮诱发的应激反应强度的相关性.方法 拟在气管插管全麻下行开腹手术(手术切口≥10 cm)的女性患者50例,ASA分级Ⅰ或Ⅱ级,年龄20～55岁.术前1 d测定痛阈和耐痛阈,并采用状态-特质焦虑问卷评价患者术前的精神状态(状态焦虑指数和特质焦虑指数).患者均采用全凭静脉麻醉(异丙酚-芬太尼-维库溴铵).于入室后平静10 min时(基础状态)、气管插管前即刻、插管后2 min、切皮前即刻和切皮后2 min时记录MAP和HR,并于相应时点抽取动脉血样,测定血浆去甲肾上腺素(NE)浓度.计算气管插管前后和切皮前后MAP、HR及血浆NE浓度的差值.术前状态焦虑指数、特质焦虑指数、痛阈、耐痛阈与气管插管前后、切皮前后MAP、HR及血浆NE浓度的差值行Pearson相关分析.结果 痛阈与气管插管前后和切皮前后MAP、HR及血浆NE浓度的差值无相关性(P＞0.05);耐痛阈与气管插管前后和切皮前后MAP的差值(r=-0.766,r=-0.688,P＜0.05)、HR的差值(r=-0.703,r=-0.638,P＜0.05)及NE的差值(r=-0.781,r=-0.781,P＜0.05)呈负相关;状态焦虑指数和特质焦虑指数与痛阈、耐痛阈以及气管插管前后和切皮前后MAP、HR及血浆NE浓度的差值无相关(P＞0.05).结论 术前耐痛阈与气管插管和切皮诱发的应激反应强度呈负相关,痛阈与气管插管和切皮诱发的应激反应强度无相关性.

Correlation of preoperative pain threshold and pain tolerance threshold with the intensity of stress reaction induced by endotracheal intubation and skin incision

Objective To investigate the correlation of preoperative pain threshold and pain tolerance threshold with the intensity of stress reaction induced by endotracheal intubation and skin incision. Methods Fifty ASA Ⅰ or Ⅱ women, aged 20-55 yr, undergoing elective abdominal surgery requiring at least a 10-cm-long skin incision under general anesthesia, were studied. The electricity dolorimeter was used to measure the patients' pain sensitivity, including pain threshold and pain tolerance, and a State Trait Anxiety Inventory (STAI) was also used to examine the mental state the day before surgery. Total intravenous anesthesia was performed in all the patients.Anesthesia was induced with TCI of propofol 4 μg/ml (effect-site concentration). After patients lost consciousness,fentanyl 3 μg/kg and vecuronium 0.1 mg/kg were injected intravenously. Tracheal intubation was performed 3 min later and the patients were mechanically ventilated. MAP and HR were recorded and arterial blood samples were taken for determination of plasma concentrations of norepinephrine (NE) at 10 min after entering operation room (T1), immediately before intubation (T2), 2 min after intubation (T3), immediately before incision (T4) and 2 min after incision (T5). The differences in MAP, HR and plasma concentrations of NE before and after intubation and skin incision were calculated. SPSS 13.0 statistical software was used to analyze the correlation of STAI,pain threshold, and pain tolerance threshold with the differences in MAP, HR and NE before and after intubation and skin incision. Results Pain threshold was not correlated with the differences in MAP, HR and NE (P ＞0.05). Pain tolerance threshold was negatively correlated with the differences in MAP (r= - 0.766, r =-0.688,P＜0.05), HR (r=-0.703, r=-0.638, P ＜ 0.05) and NE (r=-0.781, r=-0.781, P＜0.05). The STAI score was not correlated with pain threshold and pain tolerance threshold (P ＞ 0.05) .Conclusion Preoperative pain tolerance threshold is negatively correlated with the intensity of stress reaction induced by endotracheal intubation and skin incision, but there is no correlation between pain threshold and the intensity of stress reaction.