全麻诱导气管插管时大脑皮层电活动与血流动力学的变化——比较异丙酚和硫喷妥钠的药理作用

目的：探讨数量化脑电图在反映麻醉诱导气管插管期间脑电的活动程度，以及ＥＥＧ和心血管反应相关性研究。方法：７０例ＡＳＡⅠ级病人，随机双盲分两组，组Ⅰ（ｎ＝３５）硫喷妥钠，组Ⅱ（ｎ＝３５）异丙酚。硫喷妥钠或异丙酚和琥珀胆碱行气管插管。分别于诱导前、诱导后、气管插管后１～２分和３～５分监测数量化脑电图、ＭＡＰ、ＨＲ、ＳｐＯ２的变化。结果：诱导前，两组病人的ＥＥＧ及血流动力学参数无差异。诱导后，ＥＥＧ抑制，ＳＥＦ、ＭＦ、ＢＩＳ下降，δＲ升高，但两组之间无区别；异丙酚组ＭＡＰ降低程度大于硫喷妥钠组（Ｐ＜０．０１），ＨＲ无差异。气管插管后，ＥＥＧ活化，ＳＥＦ、ＭＦ、ＢＩＳ升高（Ｐ＜０．０１），δＲ降低（Ｐ＜０．０１），异丙酚组ＥＥＧ各参数的变化程度轻于硫喷妥钠组（Ｐ＜０．０１）；异丙酚组ＭＡＰ和ＨＲ升高程度小于硫喷妥钠组（Ｐ＜０．０１）。结论：气管插管前，等效剂量的异丙酚和硫喷妥钠对中枢神经的抑制程度类似，气管插管后，异丙酚组的ＥＥＧ活化程度及血流动力学的变化明显轻于硫喷妥钠。     

不同剂量异丙酚和硫喷妥钠静脉注射对血流动力学的影响

目的：研究异丙酚对血流动力学影响。方法：３０例病人（ＡＳＡⅠ～Ⅱ级）随机分为三组，第１组硫喷妥钠用量为５ｍｇ／ｋｇ，第２、３组异丙酚剂量分别为１．５ｍｇ／ｋｇ和２．５ｍｇ／ｋｇ，用阻抗法观察ＭＡＰ、ＨＲ、ＣＯ、ＣＩ、ＳＶ、ＳＩ、ＴＦＩ、ＶＥＴ、ＳＶＲ的变化。结果：注药后１０ｍｉｎＣＯ、ＣＩ、ＳＶ、ＳＩ等值在第１组下降２０％～３０％，第２组下降少于１０％，而第３组下降１０％～２０％。结论：异丙酚对循环系统影响轻于硫喷妥钠。     

全麻诱导气管插管时大脑皮层电活动与血流动力学的变化

探讨数量化脑电图在反映麻醉诱导气管插管期间脑电的活动程度，以及ＥＥＧ和心血管反应相关性研究。方法：７０例ＡＳＡⅠ级病人，随机双盲分两组，组Ⅰ（ｎ＝３５）硫喷妥钠，组Ⅱ（ｎ＝３５）异丙酚。硫喷妥钠或异丙酚和琥珀胆碱行气管插管。分别于诱导前、诱导后，气导插管后１￣２分和３￣５分监测数量化脑电图，ＭＡＰ、ＨＲ、ＳｐＯ２的变化。结果：诱导前，两组病人的ＥＥＧ及血流动力学参数无差异。诱导后，ＥＥＧ抑制、ＳＥ     

异丙酚在全麻诱导插管期间对心血管系统影响的临床研究

本研究的目的主要是观察异丙酚在全麻诱导插管期间对心血管系统的影响，并与硫喷妥钠进行临床比较。择期手术病人２０例，随机分为二组，即异丙酚组（Ｐ组）和硫喷妥钠组（Ｔ组），每组各１０例。诱导方法为静注异丙酚２．５ｍｇ／ｋｇ或硫喷妥钠６～７ｍｇ／ｋｇ和琥珀酰胆碱１．５～２．０ｍｇ／ｋｇ后气管插管。应用ＢｏＭｅｄＮＣＣＯＭ３－Ｒ７无创心功能监测仪分别在诱导前、诱导后、插管后即刻及插管后１、５ｍｉｎ测定血流动力学参数的变化。结果表明，诱导后Ｐ组的血压和ＲＰＰ明显降低而ＨＲ稍减慢，其血压下降的幅度比Ｔ组显著，而静注硫喷妥钠后ＨＲ明显增快，ＲＰＰ反而增高，说明异丙酚可能减少心肌的耗氧量。在插管后即刻Ｐ组的血压、ＲＰＰ和ＨＲ上升幅度比Ｔ组小，说明应用异丙酚时插管刺激引起的高血压反应比硫喷妥钠弱。上述表明异丙酚不失为一种良好的全麻诱导药，在老年人和其他方面的应用仍有待研究。     

异丙酚对颅脑损伤患者血浆内皮素和降钙素基因相关肽含量的影响

目的 探讨异丙酚对颅脑损伤患者开颅手术间血浆内皮素（ＥＴ）和降钙素基因相关肽（ＣＧＲＰ）含量的影响。方法 急性颅脑损伤（ＡＣＩ）患者４０例,随机分为观察组（异丙酚组,ｎ＝２０,Ａ组）和对照组（γ－羟基丁酸钠组,ｎ＝２０,Ｂ组）以放射免疫分析方法测定了４０例ＡＣＩ患者麻醉前后血浆ＥＴ,ＣＧＲＰ含量,并以４０例健康献血者为术前对照。结果 ＡＣＩ患者术前ＥＴ及ＥＴ／ＣＧＲＰ明显高于正常对照组（Ｐ〈０．０     

异丙酚和硫喷妥钠对颅脑手术患者脑血流的影响

应用经颅超声多普勒（ＴＣＤ）监测仪观察异丙酚、硫喷妥钠对颅脑手术患者大脑中动脉血流速度的影响。选择２２例择期手术患者，ＡＳＡＩ～ Ⅱ级，年龄 ２０～５８岁，随机分为二组：异丙酚组（２. ０ｍｇ／ｋｇ，ｎ＝１２例）和硫喷妥钠组（４ｍｇ／ｋｇ，ｎ＝１０例）。监测指标包括大脑中动脉血流速度（ＣＢＦＶ）、心率（ＨＲ）、平均动脉压（ＭＡＰ）和呼气末ＣＯ２分压。测定程序为给药前５分钟和给药后ＩＱ分钟，通过控制呼吸维持ＰｅｔＣＯ２相对恒定。结果表明，异丙酚组ＭＡＰ、搏动指数，峰值和平均大脑中动脉血流速度分别下降１３％、２９％、３１％和２０％，而硫喷妥钠组则分别下降９．７％、１４％、２２％和１３％。除给药后血管阻力指数异丙酚组明显低于硫喷妥钠组外，其余各指标两组间无显著差异。异而酚对脑循环的影响和硫喷妥钠相似，对颅脑手术患者麻醉诱导是有益的。     

不同剂量异丙酚和硫喷妥钠静脉注对血流动力学的影响

目的：研究异丙酚对血流动力学影响。方法：３０例病人随机分为三组，第１组硫喷妥钠用量为５ｍｇ／ｋｇ，第２、３划丙酚剂量分别为１．５ｍｇ／ｋｇ和２．５ｍｇ／ｋｇ，用阻抗法观察ＭＡＰＨＲ、ＣＯ、ＣＩ、ＳＶ、ＳＩ、ＴＦＩ、ＶＥＴ、ＳＶＲ的变化。结果：注药后１０ｍｉｎＣｏ、Ｃｉ、ＳＶ、Ｓｉ等在第１组下降２０％－３０％，第２组下降少于１０％，而第３组下降１０－２０％。结论：异丙酚对循环系统影响轻于硫喷妥钠。     

异丙酚和硫喷妥钠对离体大鼠心脏功能和细胞质膜Ca^2＋—ATPase活性的影响

目的 观察不同浓度异丙酚或硫喷妥钠对离体灌流大鼠心脏收缩力和心肌细胞质膜Ｃａ＾２＋－ＡＴＰａｓｅ活性的影响。方法 （１）以含不同浓度（１０ｕｍｏｌ／Ｌ～１０００ｕｍｏｌ／Ｌ）异丙酚或硫喷妥钠的克－汉二氏重碳酸盐缓冲液（ＫＨＢ）灌流离体大鼠心脏,测定心率（ＨＲ）、左室收缩压（ＬＶＳＰ）、左室收缩压上升最大速率（＋ｄｐ／ｄｔｍａｘ）和左室舒张压下降最大速率（－ｄｐ／ｄｔｍａｘ）。（２）参照文献制备大鼠心肌细胞质膜,观察不同浓度异丙酚或硫喷妥钠对质膜Ｃａ＾２＋－ＡＴＰａｓｅ活性的影响。结果 随着药液浓度的升高,异丙酚或硫喷妥钠使ＬＶＳＰ、＋ｄｐ／ｄｔｍａｘ逐渐降低,在等摩尔浓度的抑制作用异丙酚〉硫喷妥钠,高浓度的异丙酚或硫喷妥钠还可以减慢心率。异丙酚对质膜Ｃａ＾２＋－ＡＴＰａｓｅ活性的影响呈双相,低浓度（≤２０ｕｍｏ     

气管插管应激时血浆血栓素A2和前列环素含量变化

为比较气管插管应激时血浆血栓素Ａ２（以ＴｘＢ２表示）和前列环素（以６－ｋｅｔｏ－ＰＧＦ１ａ表示）的变化，２２例患者随机分为芬太尼组和对照组，两组患者均给予硫喷妥钠４ｍｇ／ｋｇ和琥珀胆碱１。５ｍｇ／ｋｇ诱导后插管，结果显示诱导后５分内，对照组ＳＢＰ、ＤＢＰ、ＭＡＰ、ＨＲ、ＰＡＷＰ、ＴＰＲ及血浆ＴＸＢ２含量较芬太尼组明显升高（Ｐ＜０。０５），对照组ＴＸＢ２的升高与ＭＡＰ及ＴＰＲ的升高呈高度正相关系，对     

硫喷妥钠用于全麻诱导时老年人和中青年人心血管反应的临床比较

本研究旨在了解老年人在硫喷妥钠诱导插管期间的心血管反应与中青年人有何区别。随机选择６０岁以下和６０岁以上的择期手术病人各１０例，即中青年组（Ａ组）和老年组（Ｂ组），两组均静注硫喷妥钠６～７ｍｇ／ｋｇ和琥珀酰胆碱１．５～２．０ｍｇ／ｋｇ后插管。应用ＢｏＭｅｄＮＣＣＯＭ３－Ｒ７无创心功能监测仪分别在诱导前、诱导后、插管后即刻和插管后１、５ｍｉｎ测定血流动力学参数。结果表明，应用一定剂量范围的硫喷妥钠诱导时，老年人的血压、ＣＩ、ＳＩ、ＬＣＷＩ、ＥＦ的下降程度并不比中青年人更显著。另外，老年人对插管刺激引起的高血压反应比中青年人剧烈，而其ＨＲ的上升幅度并不比中青年人显著，但如此也导致老年人的ＲＰＰ增加。因此，在老年病人为预防诱导插管期间心血管并发症的发生，应采取适当的措施来减轻插管刺激引起的心血管反应。     

Changes of arterial blood pressure and heart rate during induction of anesthesia with propofol--efficacy of propofol titration using bispectral index as an indicator]

Bispectral index (BIS) is a processed EEG parameter that measures the hypnotic effects of anesthetic and sedative agents on the brain. We studied whether propofol titration using BIS allows us to prevent hemodynamic changes during induction of anesthesia and endotracheal intubation. Thirty patients without hypertension and obesity were studied. In the titration group (n = 15), BIS was maintained at 40 during induction of anesthesia with propofol. In the bolus group, anesthesia was induced with a bolus infusion of propofol 2 mg.kg-1 (n = 15). Arterial blood pressure and heart rate were recorded before induction of anesthesia, during induction of anesthesia, immediately after, and 1 min, 2 min, and 3 min after intubation. Diastolic blood pressure and heart rate increased significantly after endotracheal intubation in both groups. Systolic blood pressure significantly increased immediately after intubation in the bolus group, but was unchanged in the titration group. These results suggest that BIS is useful to prevent significant increases in systolic blood pressure associated with endotracheal intubation during induction of anesthesia with propofol.     

不同麻醉方法对高血压病人围术期血浆中4种神经肽的影响

目的：探讨不同麻醉方法对高血压病人围术期血浆4种神经肽的影响。方法：择期上腹部手术的高血压病人60例,随机分为硬膜外组、全麻组和联合组,每组20例。分别于麻醉前、麻醉后15min、手术后20min和术终10min测定血浆中ET、CGRP、神经肽（NPY）和NT的含量及血液动力学变化。结果：在麻醉和手术后E组和G组病人的血压和4种神经肽与麻醉前相比均有显著差异（P＜0．05或0．01）。C组的血压、心纺和4种神经肽在手术开始后与组间相比差异显著（P＜0．05）。结论：两种麻醉方法联合应用于高血压患者上腹部手术,可有效地抑制手术引起的应激反应。     

星状神经节阻滞对颅内动脉瘤手术患者脑血管痉挛的影响

目的 评价星状神经节阻滞对颅内动脉瘤手术患者脑血管痉挛的影响.方法 择期行颅内动脉瘤夹闭术患者40例,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将其随机分为2组(n=20):对照组(C组)和星状神经节阻滞组(SGB组).两组均常规气管内插管,静吸复合维持麻醉.SGB组气管插管后立即以0.25%罗哌卡因10ml行左侧星状神经节阻滞.分别于切皮前、夹闭动脉瘤前、夹闭动脉瘤后30 min及术毕时采集静脉血样,测定血浆内皮素、降钙素基因相关肽及S100B蛋白水平;并于术后1、3 d时采用经颅多普勒技术监测双侧大脑中动脉和颈内动脉颅外段血流速率,记录脑血管痉挛的发生情况.术后1～7 d随访患者,记录脑缺血的发生情况.结果 与c组比较,SGB组血浆内皮素和S100B蛋白浓度降低,血浆降钙素基因相关肽浓度升高,术后脑血管痉挛及脑缺血的发生率降低(P＜0.05或0.01).结论 星状神经节阻滞可抑制颅内动脉瘤手术患者脑血管痉挛的发生,其机制与抑制血管内皮细胞释放内皮素,促进降钙素基因相关肽的释放有关.

Abstract：

Objective To evaluate the effect of stellate ganglion block (SGB) on cerebral vasospasm in patients undergoing intracranial aneurysm surgery. Methods Forty ASA Ⅱ or Ⅲ patients aged 14-64 yr weighing 40-81 kg undergoing intracranial aneurysm clipping were randomly divided into 2 groups ( n = 20 each): group control (group C) and group SGB. Left SGB was performed with 0.25% ropivacaine 10 ml immediately after intubation. Successful block was verified by development of Homer syndrome within 15 min after block. Anesthesia was induced with midazolam, propofol, fentanyl and vecuronium and maintained with isoflurane inhalation and intermittent iv boluses of fcntanyl and vecuronium. The patients were intubated and mechanically ventilated. PETCO2 was maintained at 30-35 mm Hg. BIS was maintained at 50-60. Right internal jugular vein was cannulated and the catheter was threaded cranially until resistance was met for blood sampling. Blood samples were collected before skin incision (T1), before clipping of aneurysm (T2), at 30 min after clipping (T3 ), and at the end of surgery (T4) for determination of plasma concentrations of endothelin (ET), calcium gene-related peptide (CGRP) and S100B protein. Transcranial Doppler was used to measure the flow rate of blood in bilateral middle cerebral artery and extracranial carotid artery at 1 and 3 days after surgery. All patients were observed for incidence of brain ischemia during 1-7 days after surgery. Results Plasma ET and S100B protein concentrations were significantly decreased, while plasma CGRP concentration was significantly increased after clipping of aneurysm at T3 and T4 in group SGB as compared with group C. The incidence of cerebral vasospasm and brain ischemia was significantly lower in group SGB than in group C. Conclusion SGB performed before operation can significantly reduce the incidence of cerebral vasospasm after clipping of intracranial aneurysm by inhibiting the release of ET and promoting the release of CGRP.     

Intravenous ketamine attenuates arterial pressure changes during the induction of anaesthesia with propofol

BACKGROUND AND OBJECTIVE: To investigate whether the administration of ketamine before induction with propofol produces a smaller decrease in arterial pressure. METHODS: Twenty-two patients were assigned to one of two groups to receive either propofol with ketamine (n = 11) or propofol alone (n = 11, control). Anaesthesia was induced with 2 mg kg-1 propofol and 0.5 mg kg-1 ketamine or 2 mg kg-1 propofol alone. Ketamine was administered 1 min prior to induction with propofol. Immediately after induction with propofol, vecuronium (0.15 mg kg-1) was administered. Four minutes after administration of vecuronium, tracheal intubation was performed. Anaesthesia was maintained using sevoflurane (0.5%) in 66% nitrous oxide until 3 min after intubation. Systolic, diastolic and mean arterial pressure and heart rate were recorded on arrival, directly before induction with propofol, prior to tracheal intubation, immediately after intubation and at 3 min after intubation. RESULTS AND CONCLUSIONS: Administration of ketamine before induction with propofol preserved haemodynamic stability compared with induction with propofol alone.     

乌拉地尔对高血压患者血浆4种神经肽含量的影响

目的 观察乌拉地尔（ＵＲＡ）对高血压患者血浆４种神经肽：内皮素（ＥＴ）、降钙素基因相关肽（ＣＧＲＰ）、神经肽Ｙ（ＮＰＹ）及神经降压素（ＮＴ）水平的影响。方法 选择麻醉前高血压患者２０例。于麻醉诱导前静脉注射ＵＲＡ０．５ｍｇ／ｋｇ。应用放射免疫方法测定ＵＲＡ治疗前后血浆４种神经肽的水平,并以２０例健康者作对照。结果 高血压组血浆ＥＴ、ＮＰＹ水平明显高于正常组（Ｐ〈０．０１）、血浆ＣＧＲＰ、ＮＴ水平明     

丙泊酚复合瑞芬太尼靶控输注在腹腔镜胆囊切除术中的应用

目的:观察丙泊酚复合瑞芬太尼靶控输注全凭静脉麻醉对腹腔镜胆囊切除术血流动力学及术后苏醒时间的影响。方法:50例择期行腹腔镜胆囊切除术的患者均采用丙泊酚复合瑞芬太尼靶控输注全凭静脉麻醉。设定诱导时静注咪达唑仑2mg,先血浆靶控输注瑞芬太尼4ng/ml,1min后血浆靶控输注丙泊酚3μg/ml或3.5μg/ml,患者意识消失后静注维库溴铵0.1mg/kg,3min后气管内插管,插管后丙泊酚靶浓度调至2μg/ml,术中维持根据需要调整丙泊酚靶浓度,以0.2μg/ml递增或递减,瑞芬太尼维持不变。记录诱导前、诱导后2min、插管即刻、插管后5min、气腹时、气腹后5min的收缩压(systolic bloodpressure,SBP)、舒张压(diastolic blood pressure,DBP)、心率(heart rate,HR)及术后呼吸恢复时间、呼之睁眼时间。结果:诱导后2min的SBP、DBP、HR与诱导前差异均有统计学意义(P0.05),气腹时SBP、DBP、HR有所升高,但差异无统计学意义,其他时点经适当调整丙泊酚靶浓度处理后逐渐平稳,术后呼吸恢复时间为(6.5±2.2)min,呼之睁眼时间(8.9±3.1)min。结论:丙泊酚复合瑞芬太尼靶控输注用于腹腔镜胆囊切除术安全,术中血流动力学平稳,术后苏醒快。     

不同剂量舒芬太尼复合靶控输注异丙酚麻醉诱导对患者血液动力学的影响前瞻性、多中心、随机、双盲研究

目的 评价不同剂量舒芬太尼复合靶控输注异丙酚麻醉诱导对患者血液动力学的影响,探讨复合异丙酚时舒芬太尼的适宜麻醉诱导剂量.方法 本试验为前瞻性、多中心、随机、双盲的临床研究.拟行腹部手术患者165例,ASA Ⅰ或Ⅱ级,年龄18～63岁,性别不限,体重42～90 kg,根据舒芬太尼不同麻醉诱导剂量分为4组:舒芬太尼0.4 μg/kg组(S1组,n=44)、0.6 μg/kg组(S2组,n=43)、0.8 μg/kg组(S3组,n=38)、1 μg/kg组(S4组,n=40).麻醉诱导:静脉注射咪达唑仑0.05 mg/kg,靶控输注异丙酚,血浆靶浓度3.0 μg/ml,当BIS<60且异丙酚达设定血浆靶浓度时,各组经30 s分别静脉注射舒芬太尼0.4、0.6、0.8、1 μg/kg,四组均静脉注射罗库溴铵0.9 mg/kg,静脉注射舒芬太尼后3 min(BIS 35～45)行气管插管、机械通气.于麻醉诱导前(T0)、异丙酚血浆靶浓度3.0 μg/ml时(T1)、静脉注射舒芬太尼后1 min(T2)、3 min(T3)、气管插管后即刻(T4)、1 min(T5)、3 min(T6)、5 min(T7)时记录SP、DP、MAP和HR.记录心血管不良事件和气管插管反应的发生情况.结果 四组麻醉诱导期间低血压、高血压和心动过速的发生率比较差异无统计学意义(P>0.05),T4-7时S4组心动过缓发生率较其余各组升高(P<0.05);S1组和S2组气管插管反应发生率较S3组和S4组升高(P<0.05或0.01).结论 舒芬太尼0.8 μg/kg复合靶控输注异丙酚(血浆靶浓度3.0 μg/ml)麻醉诱导时患者血液动力学平稳,是复合异丙酚时舒芬太尼适宜的麻醉诱导剂量.     

不同靶浓度丙泊酚对腹腔镜胆囊切除术患者镇静深度与应激反应的影响

目的:通过靶控输注(target-controlled infusion,TCI)不同浓度丙泊酚,研究其对腹腔镜胆囊切除术患者脑电双频指数(bispectral index,BIS)和应激反应的影响。方法:随机将60例ASAⅠ级或Ⅱ级择期行腹腔镜胆囊切除术患者分为3组,每组20例,丙泊酚TCI靶浓度分别为2.5μg/ml(Ⅰ组)、3.5μg/ml(Ⅱ组)、4.5μg/ml(Ⅲ组)。于麻醉诱导前即刻(T1)、气管插管后3min(T2)、气腹后3min(T3)、气腹后30min(T4)、气管拔管后即刻(T5),记录BIS值和收缩压(systolic pressure,SP)、舒张压(diastolic pressure,DP)、心率(heart rate,HR),同期抽取桡动脉血测定血糖和血皮质醇。结果:3组患者一般情况、麻醉时间差异无统计学意义(P>0.05),Ⅲ组苏醒时间比Ⅰ组明显延长(P<0.05);Ⅰ组BIS值于T3、T4时平均(55.3±2.2),Ⅱ、Ⅲ组明显降低(P<0.05),分别为(46.5±3.1)和(41.8±1.4);与Ⅰ组比较,Ⅱ组各时点血糖和皮质醇值差异无统计学意义(P>0.05),Ⅲ组于T3~T5时血糖和皮质醇值明显降低(P<0.05)。结论:3组靶控浓度丙泊酚均能维持满意的镇静深度,靶浓度4.5μg/ml的丙泊酚对抑制腹腔镜手术应激反应更有效,但苏醒时间较长。     

“微创”插管技术在甲状旁腺切除术全身麻醉诱导阶段的应用

目的 观察“微创”插管技术在甲状旁腺切除术气管插管全身麻醉诱导阶段的应用效果. 方法 选取拟在全身麻醉下行甲状旁腺切除术的患者100例,ASA分级Ⅲ、Ⅳ级,按随机数字表法分为微创组(L组)和对照组(C组),每组50例.麻醉诱导均采用咪达唑仑、依托咪酯、舒芬太尼、顺式阿曲库铵.L组于诱导后2.5 min用可视喉镜暴露声门,借助一次性喉麻管向喉头周围及声门内喷射2％利多卡因3 ml,继续面罩加压给氧2 min后插入7.0号超滑镇痛气管导管;C组在诱导后4.5 min应用普通喉镜插入7.5号普通气管导管.麻醉维持均采用持续泵入瑞芬太尼、丙泊酚,间断静脉注射顺式阿曲库铵.记录麻醉诱导前(T0)、插管前(T1)、插管时(T2)、插管后1 min(T3)、插管后3 min(T4)时的SBP、DBP、HR、SpO2,并分别于T1和插管后10 min(T5)抽取静脉血检测促肾上腺皮质激素(adrenocortical hormone,ACTH)和皮质醇(corticosteroid,CORT)含量(因CORT有日分泌节律,参与试验手术均安排上午). 结果 围插管期C组SBP、DBP、HR较L组明显升高,差异有统计学意义(P＜0.05),C组血中ACTH和CORT含量均较L组明显增加,差异有统计学意义(P＜0.05). 结论 “微创”插管技术可有效减少甲状旁腺切除术气管插管时心血管反应的发生,减少血液中应激激素释放,增加麻醉安全性.     

Assessment of small-dose fentanyl and sufentanil blunting the cardiovascular responses to laryngoscopy and intubation in children

BACKGROUND: The authors found no study assessing the efficacy of small-dose narcotics on the cardiovascular response from intubation in children, so they observed the effects of fentanyl 2 microg x kg(-1) and sufentanil 0.2 microg x kg(-1) on the cardiovascular changes during laryngoscopy and intubation in children. METHODS: Ninety-three children aged 3-9 years were randomized to one of three groups to receive the following treatments in a double-blind manner: normal saline (group C), fentanyl 2 microg x kg(-1) (group F) and sufentanil 0.2 microg x kg(-1) (group S) 2 min before induction. Noninvasive blood pressure (BP) and heart rate (HR) were recorded before anesthesia induction (baseline value), immediately before intubation (postinduction values), at intubation and 5 min after intubation at 1-min interval. RESULTS: Tracheal intubation caused significant increases in BP and HR in the three groups compared with baseline values. BP and HR at intubation and after intubation and their maximum values during observation were significantly lower in groups F and S than in group C (P < 0.05). The mean percent increases of systolic blood pressure (SBP) and HR at intubation were significantly lower in group S, 7% and 10%, than in group F, 17% and 25% (P < 0.05). The increases in SBP and HR of more than 30% of baseline values during the observation period were significantly higher in group F, 27% and 43%, than in group S, 0% and 3% (P < 0.05). CONCLUSIONS: When used as part of anesthesia induction with propofol in children, sufentanil 0.2 microg x kg(-1) 2 min before induction is more effective in attenuating the cardiovascular intubation response than fentanyl 2 microg x kg(-1).