艾司洛尔对老年患者非心脏手术围麻醉期应激反应的抑制作用

目的观察静脉持续输注艾司洛尔对老年患者非心脏手术围麻醉期应激反应的抑制作用。方法65岁以上择期全麻气管插管下行非心脏手术的患者40例，随机分为艾司洛尔组（n=20）与对照组（n=20）。艾司洛尔组麻醉前先静脉注射艾司洛尔0．25mg／kg，然后以20～50μg／（kg·min）的速度用输液泵持续输注，直到气管拔管后5min；对照组以生理盐水替代。记录入室、气管插管前、气管插管后即刻、切皮、手术结束、患者睁眼及拔管后即刻HR、MBP、RPP，以及入室、插管后即刻、切皮、手术结束及拔管后血糖、血香草扁桃酸（BVMA）及血皮质醇水平。结果与对照组比较，艾司洛尔组的HR、RPP在插管后即刻、患者睁眼以及气管拔管后即刻，MBP在气管插管后及睁眼时显著降低（P〈0．05），血糖值在手术结束及拔管后显著降低（P〈0．05或P〈0．01）。艾司洛尔组的芬太尼与异丙酚总量分别为（0．4±0．1）mg和（450．8±98．2）mg，显著少于对照组的（0．5±0．1）mg与（580．3±125．7）mg（P〈0．05）。结论艾司洛尔围麻醉期持续静脉输注可以很好地控制老年患者非心脏手术的应激反应，抑制围麻醉期患者血糖的升高，减少老年患者的麻醉药用量。

The Inhibitory Effect of Esmolol on Stress Response during Noncardiac Surgery in Aged

Objective To assess the inhibitory effect of esmolol on stress response during noncardiac surgery in aged. Methods 40 patients underwent noncardiac surgery, with aged of 65 years above, were randomized into esmolol group with esmolol intravenous infusion and control group with normal saline intravenous infusion, and 20 cases for each. In esmolol group, 0.25mg/kg esmolol was administrated, following a continuous intravenous infusion of 20 to 50 μg/ （kg.min） esmolol was infused until 5 minutes after tracheal extubation. The HR, MBP and RPP were studied at the time points of entering the operating room （T0） , before intubation （ T1 ）, after intubation immediately （ T2 ）, skin incision （ T3 ）, at the end of operation （ T4 ）, opening eyes on verbal command （T5） , and after extubation （ T6 ）. And the blood concentration of glucose, BVMA and serum cortisol was analyzed at the time of TO, T2, T3, T4 and T6. Results Compared with control group, the HR, RPP of T2, T5 and T6, the MBP of T2 and T5, and the concentration of glucose of T4 and T6 were decreased obviously in esmolol group （ P 〈 0.05, or P 〈 0.01 ）. The dosage of fentanyl and propofol of esmolol group was （0.4 ±0.1 ） mg and （450.8 ±98.3） mg respectively, and was significantly lower than （0.5± 0.1 ） mg and （580.3± 125.7 ） mg respectively of control group （ P 〈 0.05 ）. Conclusion Continuous intravenous infusion of esmolol can effectively inhibit the stress responses, as well as decrease the level of blood glucose and the dosage of anesthetics during noncardiac surgery in aged.