术前焦虑对丙泊酚麻醉期间意识及自主神经活性的影响  

Effect of preoperative anxiety on consciousness and autonomic nervous activity during propofol anesthesia

作　　者：马冠祺 胡颖 屠伟峰 黎翠 管金萍 张军龙 Ma Guanqi;Hu Ying;Tu Weifeng;Li Cui;Guan Jinping;Zhang Junlong(Lianyungang Clinical College of Xuzhou Medical University Department of Anesthesiology,The Second People′s Hospital of Lianyungang,Lianyungang 222000,China;The Center of Anesthsiology and Perioperative Medicine,Guangzhou Hospital of Intergrated Chinese and Wester Medicine,Guangzhou 510800,China)

机构地区：[1]徐州医科大学连云港临床学院、连云港市第二人民医院麻醉科,连云港222006 [2]广州市中西医结合医院麻醉与围术期医学中心,广州510800

出　　处：《中华麻醉学杂志》2025年第1期42-48,共7页Chinese Journal of Anesthesiology

基　　金：江苏省重点研发计划社会发展项目(BE2020771);江苏省六大人才高峰项目(WSW-208)。

摘　　要：目的评价术前焦虑对丙泊酚麻醉期间意识及自主神经活性的影响。方法本研究是一项前瞻性单臂研究临床试验数据的二次分析。选取连云港市第二人民医院拟接受丙泊酚麻醉的患者130例,年龄18~65岁,BMI 18.5~27.9 kg/m^(2),ASA分级I或Ⅱ级。术前1 h采用状态-特质焦虑量表中的六项目状态焦虑量表(SAI)评估患者焦虑状态。以12分为参考临界值将患者分为2组:焦虑症状明显组(A组,n=49),SAI评分>12分;焦虑症状不明显组(B组,n=81),SAI评分≤12分。入室后患者按要求手持装满水的50 ml注射器。靶控输注(TCI)丙泊酚血浆靶浓度5μg/ml,待效应室浓度(Ce)升至3.5μg/ml(患者意识均消失)改为闭环TCI,维持BIS值45~55;停止药物泵注后(麻醉恢复期)监测20 min。记录口头指令消失时间、睫毛反射消失时间、注射器掉落时间、口头指令恢复时间、睫毛反射恢复时间和口头指令恢复时、睫毛反射恢复时、闭环TCI的前5 min内模拟Ce以及麻醉过程中丙泊酚用量。记录外周灌注指数、心率变异性低频功率及高频功率,计算低频功率与高频功率比值。采用Pearson相关分析评价术前SAI评分与意识相关指标、丙泊酚模拟Ce和丙泊酚用量的相关性。结果与B组比较,A组口头指令消失时间、睫毛反射消失时间和注射器掉落时间延长,丙泊酚用量增加,口头指令恢复时、闭环TCI的前5 min内模拟Ce升高,给药前各时点和麻醉恢复期第14~20 min时外周灌注指数降低,麻醉维持期低频功率降低(P<0.05)。SAI评分与口头指令消失时间(r=0.220,P=0.012)、注射器掉落时间(r=0.206,P=0.029)、丙泊酚用量(r=0.330,P<0.001)、口头指令恢复时模拟Ce(r=0.215,P=0.015)和睫毛反射恢复时模拟Ce(r=0.207,P=0.022)均呈正相关。结论术前焦虑可能会导致丙泊酚麻醉期间患者意识消失时间延长,交感神经活性抑制更明显。ObjectiveTo evaluate the effect of preoperative anxiety on the consciousness and autonomic nervous activity during propofol anesthesia.MethodsThis study was a secondary analysis of data from the clinical trial in a prospective single-arm study.One hundred and thirty patients,aged 18-65 yr,with a body mass index of 18.5-27.9 kg/m^(2),of American Society of Anesthesiologists Physical Status classification I orⅡ,scheduled to receive propofol anesthesia,were selected from the Second People′s Hospital of Lianyungang.The six-item of the state anxiety inventory(SAI)of the State-Trait Anxiety Inventory was used to assess the anxiety of patients 1 h before surgery.The patients were divided into 2 groups according to the cut-off value of 12:obvious anxiety symptom(SAI score>12)group(group A,n=49)and no obvious anxiety symptom(SAI score≤12)group(group B,n=81).After admission to the operating room,the patient was required to hold a 50 ml syringe filled with water.Propofol was given by target-controlled infusion(TCI)with the target plasma concentration set at 5μg/ml.When the effect-site concentration(Ce)of propofol increased to 3.5μg/ml(all the patients lost consciousness),the closed-loop TCI was used to maintain BIS value between 45 and 55.The patients were monitored for 20 min after stopping the pump infusion(anesthesia recovery period).The disappearance time of verbal command,disappearance time of eyelash reflex,time of syringe dropping,recovery time of verbal command,recovery time of eyelash reflex,Ce at the recovery of verbal command,Ce at the recovery of eyelash reflex,Ce within the first 5 min of the closed-loop TCI,and consumption of propofol during anesthesia were recorded.The peripheral perfusion index,low frequency power and high frequency power of heart rate variability were recorded,and the ratio of low frequency power to high frequency power was calculated.Pearson correlation analysis was used to assess the correlation between preoperative SAI score and consciousness-related indicators,simulated Ce of pr

关 键 词：焦虑 二异丙酚 意识 自主神经系统 

分 类 号：R614[医药卫生—麻醉学]