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  • Title: [Effects of propofol sedation on psychological stress in surgical patients under epidural].
    Author: Mo X, Liang H, Xiao Y, Wen Y, Yuan Y, Jin S.
    Journal: Nan Fang Yi Ke Da Xue Xue Bao; 2018 Dec 30; 38(12):1498-1502. PubMed ID: 30613020.
    Abstract:
    OBJECTIVE: To explore the effects of propofol sedation on psychological stress in patients undergoing surgery under epidural anesthesia. METHODS: Sixty patients scheduled to undergo elective ileostomy closure under epidural anesthesia were randomized into propofol sedation group and control group (n=30). The patients in the sedation group received a loading dose of propofol of 0.6 mg·kg- 1· h- 1 followed by a maintenance dose with continuous infusion of 3 mg·kg- 1· h- 1 given after the Observer's Assessment of Alertness/Sedation (OAA/S) score reached 2-3. An equivalent volume of normal saline was administered in patients in the control group. The patients' preoperative and intraoperative anxiety scores were assessed with the State Anxiety Inventory (SAI) on the day before and on the first day after the surgery, respectively. The mean blood pressure (MBP), heart rate (HR), SpO2, OAA/S, and the indicators of psychological stress of brain functional state of the patients (including the wavelet index [WLi], anxiety index [ANXi], comfortable index [CFi] and pain index [Pi]) were recorded at 5 min after entering the operating room (T0), at the time of lumbar puncture (T1) and change to supine position after the puncture (T2), at 20 s (T3), 40 s (T4), and 60 s (T5) after intravenous administration, and at 2 min (T6), 4 min (T5), 6 min (T8), 8 min (T9), 10 min (T10) and 40 min (T11) after skin incision. The patient's satisfaction with anesthesia was assessed with the Visual Analog Scale (VAS) score on the first day after the operation. Serum cortisol level was measured before anesthesia and at the end of operation to calculate the changes in cortisol level. RESULTS: The two groups of patients were comparable for preoperative SAI scores (P&gt;0.05); The patients in the sedation group appeared to have lower intraoprative SAI scores, but this difference was not statistically significant (P=0.05). MBP, HR, and SpO2 at the time points from T6 to T10 and OAA/S, WLi, ANXi, CFi, and Pi at the time points from T6 to T11 were significantly lower in the sedation group (all P &lt; 0.05), and these parameters were not significantly different between the two groups at the other time points (all P&gt;0.05). The patient satisfaction scores were significantly higher in the sedation group (Z=2.07, P &lt; 0.05). Compared with the preoperative levels, serum cortisol level at the end of the operation was increased in the sedation group but lowered in the control group, and the variations of serum cortisol level differed significantly between the two groups (t=4.75, P &lt; 0.01). CONCLUSIONS: Intraoperative propofol sedation can alleviate the patients' anxiety, improve the comfort level, and lessen physiological stress during surgeries under epidural anesthesia. 目的: 探讨丙泊酚镇静辅助硬膜外麻醉对患者心理应激的影响。 方法: 60例在硬膜外麻醉下择期行回肠造口关闭术患者，通过随机数字法将其分为镇静组（P组）和对照组（C组），每组30例。镇静组静脉给予丙泊酚负荷剂量0.6 mg·kg-1·min-1，警觉/镇静（OAA/S）评分达2~3分时调整为维持量3 mg·kg-1·h-1，手术结束时停用丙泊酚；对照组给予等量生理盐水。使用状态焦虑量表（SAI）于术前1 d和术后第1天分别评定患者术前和术中焦虑程度；记录入室安静5 min（T0）、椎管内穿刺时（T1）、穿刺完成平卧位时（T2）、给静脉药后20（T3）、40（T4）、60（T5）s、手术开始后2（T6）、4（T7）、6（T8）、8（T9）、10（T10）、40（T11）min患者的MBP、HR、SpO2、OAA/S评分以及脑功能状态指标：小波指数（WLi）、焦虑指数（ANXi）、舒适指数（CFi）和疼痛指数（Pi）。用视觉模拟量表（VAS）于术后第1天调查患者的麻醉满意度。测定麻醉前和术毕血清皮质醇浓度，计算△皮质醇浓度=麻醉前皮质醇浓度-术毕皮质醇浓度。 结果: 两组患者术前SAI差异无统计学意义（P>0.05）；镇静组患者术中SAI较低，但差异无统计学意义（P=0.05）。镇静组患者T6~T10时间点的MBP、HR、SpO2和T6~T11时间点的OAA/S、WLi、ANXi、CFi、Pi较低，差异有统计学意义（P均 < 0.05）；两组其余时间点的上述指标比较差异无统计学意义（P均>0.05）。镇静组患者对麻醉的满意度较高（Z=2.07，P < 0.05）。镇静组患者△皮质醇浓度为正值，说明患者皮质醇浓度术毕较麻醉前低，而对照组患者△皮质醇浓度为负值，说明患者皮质醇浓度术毕较麻醉前高，两组间△皮质醇浓度有统计学差异（t=4.75，P < 0.01）。 结论: 硬膜外麻醉时辅以丙泊酚镇静与单纯硬膜外麻醉相比，能够降低患者的心理和生理应激，明显缓解患者焦虑情绪，提高患者的舒适度及对麻醉的满意程度。
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