异丙酚注射痛与气管插管应激反应的相关性

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

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ASAⅠ-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(2mg/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5min(基础状态)、气管插管前即刻、插管后1、2、3min时收缩压、舒张压及心率,计算心率收缩压乘积(heart rate-bloodpressure product,RPP)。结果异丙酚注射痛的发生率为68%。气管插管后1min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1min 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1min 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。

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,P0.01）.RPP at T1 was not correlated with propofol injection-induced pain（R2=0.071 9,P0.05）.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.