不同药物用于支撑喉镜手术气管插管时的血流动力学比较

目的比较瑞芬太尼、丙泊酚、艾司洛尔用于支撑喉镜手术气管插管时患者的心血管反应。方法选取2009年13月就诊的60例拟于全身麻醉下行择期支撑喉镜下声带息肉切除术的患者,随机分为丙泊酚组、艾司洛尔组和瑞芬太尼组,每组20例。麻醉诱导采用咪达唑仑、芬太尼和丙泊酚,患者意识消失后给予琥珀胆碱。1min后各组分别给予丙泊酚2mg/kg、艾司洛尔1mg/kg和瑞芬太尼1μg/kg。30s后进行气管插管。记录患者诱导前及插管前、插管后1、3、5min的心率和血压水平。结果各组插管前的收缩压和心率较诱导前明显降低,插管后1、3min的收缩压和心率较插管前升高（P〈0.05）。丙泊酚组和艾司洛尔组插管后的收缩压较瑞芬太尼组升高（P〈0.05）。丙泊酚组插管后心率较瑞芬太尼组增加（P〈0.05）。结论对行支撑喉镜手术的患者,气管插管前30s给予1μg/kg瑞芬太尼较2mg/kg丙泊酚和1mg/kg艾司洛尔能更有效地减轻气管插管时的血流动力学反应。

Comparison of the Effects of Remifentanil,Propofol and Esmolol on Hemodynamic Responses During Intubation in CO2 Laser Endolaryngeal Microsurgery

Objective To assess the different effects of remifentanil,propofol,and esmolol on hemodynamic responses during intubation in CO2laser endolaryngeal microsurgery（CO2-LELM）.Methods A total of 60patients aged from 18to 65years,admitted from January to March 2009and scheduled to undergo elective CO2-LELM under general anesthesia for treatment of vocal cord polyp were randomly assigned to a propofol group,an esmolol group,and a remifentanil group.Anesthesia was induced with midazolam（0.015-0.02mg/kg）,fentanyl（1μg/kg）,and propofol （1mg/kg）.After the patients became unconscious,succinylcholine（1mg/kg）was given one minute later.Then the patients in the three groups received propofol（2mg/kg）,esmolol（1mg/kg）,and remifentanil（1μg/kg）,respective-ly.Intubation was performed 30secconds later.Heart rate（HR）and systolic blood pressure（SBP）were measured noninvasively before general anesthesia induction（baseline,Tb）,just before intubation（Ti）,and one,three,and five minutes after intubation（T1,T3,T5）.Results The demographic data including age,sex and body weight were comparable in the three groups.Tracheal intubation caused significant increases in SBP and HR in all groups compared with Ti（P0.05）.After intubation,SBP in the propofol group and the esmolol group were significantly higher than that in remifentanil group（P0.05）,and HR in the propofol group was significantly higher than that in the remifentanil group（P0.05）.Conclusion In patients with CO2-LELM,remifentanil（1μg/kg）administrated 30seconds before intubation is maximal effective compared with propofol（2mg/kg）or esmolol（1mg/kg）in attenuating the hemodynamic responses to oraltracheal intubation.