不同剂量艾司洛尔复合异丙酚对气管插管时应激反应的影响

目的 了解艾司洛尔预防气管插管引起的血流动力学变化的合理用量。方法 30例病人随机分为3组。A组为对照组，B组为0．5mg.kg^-1艾司洛尔组，C组为1．0mg.kg^-1艾司洛尔组。静注异丙酚和维库溴铵诱导气管内插管。监测插管后1、3、5及10min收缩压（SP）、舒张压（DP）、心率（HR）；并抽取血标本用高压液相色谱仪测血浆中去甲肾上腺素（NE）、肾上腺素（E）和多巴胺（DA）浓度。结果 A组插管后1min时血压、心率显著升高（P＜0．01）或0．05）。B组插管后3、5及10min时血压、心率显著降低（P＜0．01或0．05）；3及5min时去甲肾上腺素与肾上腺素水平显著降低（P＜0．01或0．05），与B组比较，插管后1和3min时肾上腺素水平显著降低（P＜0．01）。结论 1．0mg.kg^-1艾司洛尔复合异丙酚可缓解插管时的循环反应及儿茶酚胺反应。

Influences of different doses of esmolol on intubation response

Objective Trying to find out the ideal dose of esmolol for preventing hemodynamic changes induced by the endotracheal intubation (EI). Methods Thirty adult ASA Ⅰ-Ⅱ patients scheduled for noncardiac surgery under general anesthesia were randomly divided into three groups. Age ranged from 18-78 years and body weight between 50-80 kg. The patients were premedicated with intramuscular pethidine 50 mg and scopolamine 0.3 mg. Before anesthesia the patients received lactated Ringer solution 300 ml intravenously in 30 min and baseline systolic blood pressure(SP), diastolic blood pressure(DP) and heart rate (HR) were measured and recorded and first blood samples was taken for determination of epinephrine (E), norepinephrine (NE) and dopamine (DA) by high performance liquid chromatography. Anesthesia was induced with intravenous fentanyl 0.2 ug/kg, propofol 1.5 mg/kg and vecuronium 0.15 mg/kg. Group A received normal saline 10 ml intravenously, group B esmolol 0.5 mg/kg and group C esmolol 1.0 mg/kg given intravenously over 10 seconds. After 2 min mechnical ventilation with pure oxygen by mask, tracheal intubation was performed using curved laryngoscope under direct vision. After intubation mechanical ventilation was atarted and PET CO2 was maintained between 30-40mmHg. 1,3, 5 and 10 min after intubation SP, DP and HR were checked and recorded. Blood samples were taken 1, 3, and 5 min after intubation. 10 min after intubation inhalation of isoflurane, nitrous oxide and oxygen was started for maintenance of anesthesia. Results There were no statistically significant differences in sex, age and body weight between the three groups. In group A, HR, SP, DP and RPP increased significantly at 1,3 min after EI (P<0.01 ). In group B SP, DP and RPP decreased significantly at 3 and 5 min after EI (P<0.05). In group C SBP, DBP and RPP at 1, 3, 5 and 10 min after EI were significantly lower than baseline values. NE and E levels increased significantly at 3 and 5 min after El in group A, but decreased significantly at 1,3 and 5 min after EI in group C. Conclusions Esmolol 1.0mg@kg-1 may attenuate catecholamine response to EI without obvious depression of BP and HR.Key Words Intubation, intratracheal; Esmolol; Propofol; Stress; Hemodynamics