Correlation Between Blood Pressure, Heart Rate and Plasma Corticotropin, Cortisol Under Surgical Skin Incision
Condition: Stress, Psychological
MeSH terms: Stress, Psychological
Study type: Observational

Summary: 
      A prospective observational study was conducted to analyze the correlation between systolic
      blood pressure, diastolic blood pressure, mean arterial pressure，heart rate and plasma
      corticotropin, cortisol during surgical skin incision.
    

Detailed description: 
      The elements of general anesthesia include sedation, analgesia and muscle relaxation, while
      the essence of intraoperative pain in patients under general anesthesia is the body's
      unconscious response to tissue damage, namely the stress response.Stress response is a series
      of hormonal and metabolic changes produced by the body in response to nociceptive stimuli. It
      is part of the systemic response to injury and includes a wide range of endocrine,
      immunological and hemodynamic effects.Operation as well as the modern medicine common disease
      treatment, as a harmful stimulation, can cause the body strong stress reaction, reaction and
      duration and the size of the surgery is often proportional to the damage degree, its
      mechanism mainly include the activation of the sympathetic nervous system,
      adrenocorticotropic hormone (ACTH), growth hormone, vasopressin (AVP), cortisol and
      aldosterone and a series of hypothalamus pituitary adrenal axis hormone changes, insulin
      resistance and stress hyperglycemia, IL - 1, IL - 6, TNF alpha, such as the change of
      cytokines,And the increase in acute phase reactions such as acute response phase protein
      (CRP).As a protective response, stress response can mobilize the energy stored in the body
      when the body is injured, and help the body survive in harsh environment.But now a good
      perioperative management environment means that patients can be adequately nourished even
      after surgery.In this case, excessive stress response leads to preoperative anxiety of
      patients, the occurrence of adverse events in the intraoperative central blood vessels, and
      the occurrence of postoperative complications.In surgical patients, many systems, including
      the brain, are negatively affected by stress hormones.Perioperative acute stress can lead to
      post-traumatic stress disorder, depression, postoperative fatigue, chronic pain, and
      cognitive decline in elderly patients.Perioperative hyperglycemia and insulin resistance are
      closely related to postoperative infection and cardiovascular events, and may prolong
      hospital stay.Perioperative stress response will also damage the immune function of patients,
      which is mainly manifested as inhibition of natural killer cell function and inhibition of
      innate immune function response, which brings concerns about postoperative infection and
      tumor recurrence of patients.Anesthesia can inhibit the intraoperative stress of patients to
      a certain extent. Different anesthesia drugs and anesthesia methods can be selected for the
      same operation.Dexmedetomidine has dose-dependent sedative, analgesic, anti-anxiety and
      hypnotic effects. It can reduce serum s-100 protein, lipid peroxidation product
      malondialdehyde (MDA), raise the level of hyper oxide dismutase (SOD), and reduce TNF-, il-1,
      il-6 and other pro-inflammatory mediators.Fentanyl, rui fentanyl, sufentanil opioids can
      inhibit the hypothalamus pituitary adrenal axis, decrease the plasma levels of stress
      hormones, but this does not mean that the investigators can in the art of unlimited increase
      the drug, also want to consider the stability of hemodynamics, respiratory depression caused
      by delayed awakening, postoperative nausea and vomiting, postoperative itching and
      postoperative recovery of gastrointestinal, etc.;Epidural anesthesia with segmental
      sympathetic nerve blocking effect, in the chest surgery, general anesthesia compound epidural
      block than all by intravenous anesthesia, the patient's heart rate, blood pressure, mean
      arterial pressure, such as index significantly more smoothly, catecholamine levels in
      peripheral blood, the incidence of postoperative adverse events also significantly
      reduced.Real-time monitoring of the intraoperative stress level of patients is helpful for
      the anesthesiologist to determine the depth of anesthesia and guide the intraoperative
      anesthesia medication.There are many ways to monitor the level of intraoperative stress in
      patients.Surgical volume index (SPI) is used to monitor the pain-analgesic balance during
      general anesthesia through heartbeat interval and pulse wave amplitude measured by light.Skin
      pain conductance meter (SCA) assesses the size and pain of nociceptive stimulation through
      sweating and skin conductance.The pupil pain index (PPI) monitors intraoperative pain by
      measuring changes in pupil size caused by nociceptive stimulation.All of these indicators
      were used to monitor the intraoperative stress level through sympathetic or parasympathetic
      nerve activity. However, the intraoperative acute stress response was related to the state of
      high adrenocorticotropin and high cortisol. Currently, there is no index to evaluate the
      intraoperative pain of patients based on the change of intraoperative stress hormone
      level.However, the changes of stress hormones must be detected by laboratory tests.
      Therefore, whether the changes of stress hormones can be estimated by the blood pressure and
      heart rate that the investigators routinely monitor during the operation, so as to provide a
      research direction for us to establish the intraoperative pain monitoring method with stress
      hormones as the evaluation standard.In summary, this clinical study analyzed the relationship
      between the changes of systolic blood pressure, diastolic blood pressure, mean arterial
      pressure and heart rate under surgical curettage stimulation and the changes of plasma
      adrenocorticotrophin and cortisol through prospective observational studies, and found out
      the indexes that could reflect the changes of stress hormones during the operation.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The enrolled patients were mainly male and the type of surgery was open upper abdominal
        surgery
      
Keywords: Stress; Blood pressure; Heart rate; Corticotropin; Cortisol