术前高度焦虑相关致痛因子的变化及其对术后疼痛的影响

Changes in severe preoperative anxiety related pain factors and their effect on postoperative pain

目的探讨术前高度焦虑相关致痛因子的变化及其对术后疼痛的影响。方法选择择期在全麻下行腹腔镜手术患者71例,男27例,女44例,年龄18~60岁,ASAⅠ或Ⅱ级,根据术前24h内患者状态焦虑量表评分(SAI),将患者分为高度焦虑组(SA组,SAI>45,n=31)和低度焦虑组(MA组,SAI≤45,n=40),以ELISA法测定术前血浆前列腺素E_2(PGE_2)、P物质(SP)及5-羟色胺(5-HT)浓度。于术后3、6、12、24h评估患者VAS疼痛评分及24h镇痛泵按压总次数,计算致痛因子与VAS评分的相关性;术后2个月评估慢性疼痛发生情况。结果与MA组比较,SA组术后3、6、12、24h的VAS评分明显升高(P<0.05),24h镇痛泵按压次数明显增多(P<0.05),且术后2个月慢性疼痛发生率明显升高(P<0.05);SA组术前血浆PGE_2、5-HT浓度明显高于MA组(P<0.05),但SP浓度差异无统计学意义;PGE_2与术后VAS评分呈中度正相关(r_(3h)=0.54、r_(6h)=0.51、r_(12h)=0.50、r_(24h)=0.51,P<0.05),5-HT浓度与术后VAS评分呈低度正相关(r_(3h)=0.30、r_(6h)=0.37、r_(12h)=0.28、r_(24h)=0.32,P<0.05)。结论术前高度焦虑患者伴血浆PGE_2和5-HT浓度升高,且与术后疼痛程度呈一定的相关性;术前高度焦虑还可导致术后慢性痛发生率增加。

Objective To study the changes of severe preoperative anxiety related pain factors and their effect on postoperative pain.Methods A total of 71 patients,27 males and 44 females,aged18-60 years,ASA physical statusⅠ orⅡ,undergoing laparoscopic surgery under general anesthesia were selected.According to the results of the patient′s state anxiety scale（SAI）score within 24 hours before surgery,patients were divided into severe anxiety group（group SA,SAI〉 45,n = 31）and mild anxiety group（group MA,SAI≤ 45,n = 40）.Preoperative plasma prostaglandin E2（PGE2）,substance P（SP）and 5-hydroxytryptamine（5-HT）concentrations were measured using ELISA.VAS pain score was measured at 3,6,12 and 24 hours after operation.The times of pressing analgesia pump was recorded.Chronic pain was assessed 2 months after surgery.Results Compared with group MA,group SA had a higher 24-hour analgesic dosage and VAS score at 3,6,12 and 24 hours after operation（P 〈 0.05）,and the incidence of chronic pain was significantly higher 2 months later（P 〈 0.05）.The preoperative plasma PGE2 and 5-HT levels in group SA were significantly higher than in group MA（P 〈0.05）,while there was no significant difference in SP concentration between the two groups.The concentration of PGE2（r3h=0.54,r6h=0.51,r12h=0.50,r24h=0.51,P 〈0.05）and 5-HT（r3h=0.30,r6h=0.37,r12h=0.28,r24h=0.32,P 〈0.05）was positively correlated with the postoperative pain level.Conclusion Patients with preoperative high-anxiety elevate plasma PGE2 and 5-HT concentrations,which are positively associated with postoperative pain;preoperative high anxiety can also lead to increased postoperative chronic pain.