达克罗宁胶浆对老年高血压患者全麻诱导气管插管期间应激反应的影响

目的：评价达克罗宁胶浆对老年高血压患者全麻诱导气管插管期间应激反应的影响。方法选择择期行气管插管全麻手术的患者60例，ASAⅡ～Ⅲ级，年龄＞70岁，性别不限，Allen′s试验阴性，有高血压基础疾病，但高血压基本控制，无冠心病、糖尿病、哮喘等其他疾病史。随机分成4组：空白对照组、含服组、涂抹组、含服＋涂抹组，每组15例。空白对照组术前在咽喉部含服8 mL空白胶浆，5 min后咽下，导管前端1／3处均匀涂抹2 mL空白胶浆；含服组术前含服8 mL达克罗宁胶浆，5 min后咽下，导管前端1／3处均匀涂抹2 mL空白胶浆；涂抹组术前含服8 mL空白胶浆，5 min后咽下，导管前端1／3处均匀涂抹2 mL达克罗宁胶浆；含服＋涂抹组术前含服8 mL达克罗宁胶浆，5 min后咽下，导管前端1／3处均匀涂抹2 mL达克罗宁胶浆。入室后行常规生命体征监测，行桡动脉穿刺，有创动脉压监测收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）。静息10 min（T0）后记录SBP／DBP、心率（ HR）、脉搏氧饱和度（ SpO2）作为基础值。用相同麻醉方法行麻醉诱导，并用相同麻醉方法行麻醉维持。记录插管即刻（T1）、插管3 min（T2）、插管5 min（T3）、插管10 min（T4）5个时间点患者的SBP、DBP、HR和SpO2。结果4组患者T1时点与T0时点比较：SBP均有增高，其变化幅度分别是10.8％、5.3％、1.4％、0.7％；DBP增减幅度分别是5.2％、－3.9％、－5.2％、－7.5％；HR增减幅度分别是10.7％、11.7％、－3.8％、－1.4％；T2、T3、T4时点SBP、DBP和HR均较T0时点降低（ P＜0.05）；T1时点与对照组比较，含服组SBP、DBP、HR差异无统计学意义（P＞0.05），涂抹组SBP、DBP、HR较小（P＜0.05）；T1时点含服＋涂抹组与含服组比较SBP、DBP、HR较小（P＜0.05），与涂抹组比较，SBP、DBP、HR较小（P＜0.05）。结论老年高血压患者插管全麻前应用1％达克罗宁胶浆含服联合气管导管前端1／3涂抹法，可以抑制气管插管的心血管应激反应，有利于维持老年高血压患者全麻诱导气管插管期间血流动力学的稳定，可在临床中选用。

The effects of dyclonine hydrochloride muciluge on stress reaction during induction and tracheal intubation in eld-ers with general anesthesia

Objective To evaluate the effects of dyclonine hydrochloride muciluge on stress reaction during in-duction and tracheal intubation in elders with general anesthesia .Methods Sixty patients ( ASAII-III, over 70 yrs) scheduled for general anesthesia with tracheal intubation enrolled with the inclusion criteria , including negative Allen′s ex-periment, controlled hypertension , no coronary heart diseases , no diabetes, and no asthma or other disease .All patients were randomly divided into control group , dyclonine hydrochloride muciluge buccal group , dyclonine hydrochloride muci-luge smear group, dyclonine hydrochloride muciluge buccal and smear group .In control group, 8ml control glue was giv-en, and 2ml control glue was smeared on the distal third of tracheal tube before anesthesia induction .In buccal group, 8ml dyclonine hydrochloride muciluge was given , and 2ml control glue was smeared on the distal third of tracheal tube be-fore anesthesia induction .In smear group, 8ml control glue was given , and 2ml dyclonine hydrochloride muciluge was smeared on the distal third of tracheal tube before anesthesia induction .In buccal and smear group , 8ml dyclonine hydro-chloride muciluge was given , and 2ml dyclonine hydrochloride muciluge was smeared on the distal third of tracheal tube before anesthesia induction .The invasive radial artery SBP , DBP and MAP were monitored .The same anesthesia protocol was given.The SBP, DBP, MAP and SpO2 at baseline (T0), at intubation (T1), 3 min after intubation (T2), 5min af-ter intubation (T3), and 10min after intubation (T4) were recorded.Results In all the 4 group, the SBP was increased by 10.8%, 5.3%, 1.4% and 0.7% at T1 when compared with T 0; the DBP was changed by +5.2%, -3.9%,-5.2%and -7.5%;and the HR was changed by +10.7%, +11.7%, -3.8%and -1.4%.Significant reductions in SBP, DBP and HR were revealed at T2, T3 and T4 when compared with T0 in all the 4 groups (P<0.05).Compared with control group , no significant difference in SBP , DBP or HR at T1 in buccal group was observed ( P>0.05);as sig-nificant reductions in SBP, DBP and HR were observed at T1 in smear group (P<0.05).Comparing with smear group, the SBP, DBP and HR at T1 in buccal and smear group is significantly lower (P>0.05).Comparing with the buccal group, the SBP, DBP and HR at T1 in buccal and smear group was significantly lower (P>0.05).Conclusion The ap-plication of dyclonine hydrochloride muciluge buccaling combined smearing on the distal third of tracheal tube in the elder -ly patients with essential hypertension before general anesthesia inhibits cardiovascular stress reaction , and promotes main-tenance the hemodynamic stability during general anesthesia induction and intubation .