异丙酚注射痛与气管插管应激反应的相关性

 目的  探讨异丙酚注射痛与气管插管应激反应的相关性。方法 选择50例ASA Ⅰ Ⅱ级、拟在气管插管全麻下行腹腔镜手术的女性患者,经右手背建立静脉通路,并推注1/3诱导剂量(2 mg/kg)的异丙酚,同时记录注射部位疼痛评分;以异丙酚、舒芬太尼、罗库溴铵进行全麻诱导及气管插管,记录入室后平静5 min (基础状态)、气管插管前即刻、插管后1、2、3 min时收缩压、舒张压及心率,计算心率收缩压乘积(heart rate blood pressure product,RPP)。结果  异丙酚注射痛的发生率为68%。气管插管后1 min患者血压以及心率增幅最大,患者异丙酚注射痛评分与插管后1 min RPP显著相关(R2=0.373 2,P<0.01),与插管前RPP相关性不明显(R2=0.071 9,P>0.05)。以异丙酚注射痛评分≥2预测插管后1 min RPP大于基础值20％的灵敏度为77.8％,特异度为68.3％。结论  手术前异丙酚注射痛与气管插管应激反应具有显著相关性。

The correlation of propofol injection-induced pain and stress reaction after tracheal intubation

Objective  To investigate the correlation of propofol injection induced pain and stress reaction after intubation.Methods  Fifty female patients with ASAⅠ Ⅱscheduled for laparoscopic surgery were enrolled into this study.The patients′ blood pressure,heart rate and SPO2 were monitored before anesthesia induction.Then they were injected with one third of scheduled propofol via a dorsal hand vein.Their pain scale (verbal rating scale) during the injection of propofol was evaluated.The residue propofol and 0.5 μg/kg sufentanil were injected.After patients lost consciousness,rocuronium 0.6 mg/kg was injected.Tracheal intubation performed 3 min later and the patients were mechanically ventilated.SBP,DBP and Hr were recorded at different time points:before anesthesia (T1),before intubation (T2),1 minute (T3) after intubation,2 minute (T4) and 3 minute (T5) after intubation.Results  Pain occurred in 68% of the patients.SBP and Hr at T3 increased significantly compared with that at T4 and T5.RPP at T3 significantly correlated with propofol injection induced pain (R2=0.373 2,P<0.01).RPP at T1 was not correlated with propofol injection induced pain (R2=0.071 9,P>0.05).The sensitivity and specificity of propofol injection induced pain (≥2) that predicting RPP at T1 more than 20 percent compared with base value were 77.8% and 68.3% respectively.Conclusions  Preoperative propofol injection induced pain is significantly correlated with stress reaction after intubation.