术前焦虑对腹腔镜下子宫切除患者术后疼痛及阿片类药物用量的影响

The effects of preoperative anxiety on postoperative pain and opioid consumption in patients undergoing laparoscopic hysterectomy

目的评价术前焦虑状态对腹腔镜下子宫切除患者术后疼痛及围手术期阿片类药物用量的影响。方法选择南方医科大学珠江医院妇产科2014年11月~2015年8月择期行腹腔镜下子宫切除术患者40例,年龄18~65岁,ASAⅠ或Ⅱ级,术前1d行状态焦虑量表（SAI）评估。按照SAI评分将患者分为低焦虑组（L组,SAI≤37,n=18）和高焦虑组（H组,SAI〉37,n=22）。记录患者麻醉时间、术中瑞芬太尼用量、从停用瑞芬太尼到首次给予舒芬太尼的时间（首剂时间）;记录术后1h（T_1）、2h（T_2）、4h（T_3）、6h（T_4）、24h（T_5）及48h（T_6）患者舒芬太尼用量、PCIA按压次数、视觉模拟量表（VAS）评分和术后48h内不良反应的发生情况。结果术后各时点H组舒芬太尼用量明显大于L组（P〈0.05）;H组舒芬太尼首剂时间[（9.1±6.5）min]明显短于L组[（15.8±11.9）min]（P〈0.05）;术后各时点两组VAS评分差异无统计学意义;T_5时H组PCIA按压次数明显多于L组（P〈0.05）;术后48h内两组恶心呕吐发生率差异无统计学意义,且均无呼吸抑制、皮肤瘙痒及尿潴留发生。结论术前高焦虑状态可增加术后疼痛感知,术后需要更多的阿片类药物。

Objective To evaluate the effect of preoperative anxiety on the dosage of opioid drugs in perioperative period.Methods Fourty female patients who aged 18-65 years,ASA Ⅰ or Ⅱ, undergoing laparoscopic hysterectomy were enrolled during November 2014 to August 2015.Demo-graphic characteristics of the patients were recorded.The patients were separated into two groups ac-cording to their state anxiety inventory （SAI）.The patients with SAI〉37 score were included in the high-anxious patients group （group H,n=22）while the other patients with SAI≤37 were enrolled in the low-anxious patients group （group L,n=18）.All patients received the SAI test at the day be-fore surgery.The anesthesia time,intraoperative remifentanil consumption,duration of the first time giving analgesia after surgery,consumption of sufentanil at 1（T1 ）,2（T2 ）,4（T3 ）,6（T4 ）,24（T5 ） and 48 hours（T6 ）after operation were recorded.Visual analogue scale （VAS）scores,the times of pressing PCIA and the side effects of opioid 48 h after the surgery were recorded.Results In group H, the time for first dose of opioid after surgery was significantly shorter than group L （P 〈0.05）.The con-sumption of sufentanil in group H was significantly more than group L at T1-T6 （P 〈0.05）.The times of pressing PCIA at the T5 time point after operation in group H was more than group L （P〈0.05）.No sta-tistically difference was found in the incidence of nausea or vomit between the two groups.There were no re-spiratory depression, pruritus or urinary retention in all patients.Conclusion Patients with high preoperative anxiety level perceive needed more opioids in postoperative pain control.