Effects of diazoxide on the cardiovascular response to tracheal intubation

The efficacy of 2 or 3 mg/kg diazoxide given 2.5 min before laryngoscopy in attenuating the cardiovascular responses to laryngoscopy and intubation was studied in 30 patients undergoing elective surgery. Data were compared with those from 10 control patients receiving saline. Anaesthesia was induced using 5 mg/kg thiopentone given intravenously and tracheal intubation was facilitated with 0.2 mg/kg vecuronium bromide. Patients receiving saline showed a significant increase in mean arterial pressure and rate-pressure product associated with tracheal intubation. The increases following tracheal intubation were significantly reduced (P less than 0.05) in diazoxide-treated patients compared with those in the control group, but there were no significant differences in heart rate following tracheal intubation among the three groups. Data suggest that diazoxide can be used as a supplement during induction of anaesthesia to attenuate the hypertensive response associated with laryngoscopy and tracheal intubation.     

舒芬太尼对气管插管患者血浆儿茶酚胺类激素的影响

目的 观察舒芬太尼对全麻患者气管插管后血浆肾上腺素(E)和去甲肾上腺素(NE)浓度的影响.方法 将于该院行气管插管的114例患者分为对照组和观察组(各57例),全麻诱导均采用地塞米松、咪达唑仑、异丙酚和维库溴铵,对照组加用芬太尼3 μg/kg,观察组加用舒芬太尼0.5 μg/kg,比较分析两组患者插管即刻及插管后1、3、5 mim时血浆E和NE浓度的变化.结果 对照组在插管后1、3 min时血浆E、NE浓度均高于插管即刻(P＜0.05),观察组插管即刻及插管后各时间点血浆E、NE浓度变化无统计学意义(P＞0.05).结论 舒芬太尼在全麻患者气管插管时,对血浆儿茶酚胺类激素的影响小,比芬太尼更能有效抑制气管插管应激反应.     

艾司洛尔和芬太尼对高血压患者气管插管循环反应影响的研究

目的 :比较艾司洛尔和芬太尼对高血压患者气管插管时循环和儿茶酚胺反应的影响。方法 :将 6 0例美国麻醉医师协会 (ASA)分级标准 ～ 级且行气管插管全麻手术的高血压患者随机分为 4组 ,分别于插管前静脉注射生理盐水 (A组 )、 2 m g/ kg艾司洛尔 (B组 )、2 μg/ kg芬太尼 (C组 )和 2 mg/ kg艾司洛尔 +2 μg/ kg芬太尼 (D组 )。静脉给咪唑安定、阿曲库胺和异丙酚诱导插管。测定插管前后收缩压 (SAP)、舒张压 (DAP)、心率 (HR)、心率收缩压乘积 (RPP)及血浆去甲肾上腺素 (NA)和肾上腺素 (A)浓度。结果 :气管插管后 1min和3min,A组患者 SAP、DAP、HR、RPP、NA和 A均非常显著高于基础水平 (P<0 .0 5或 P <0 .0 1) ,B组患者NA和 C组患者 SAP插管后均明显升高 (P均 <0 .0 5 ) ,D组患者气管插管后 SAP、DAP、HR和 NA、A水平与基础值比较无明显差异 (P均 >0 .0 5 )。结论 :高血压患者气管插管有明显循环和应激反应 ,2 mg/ kg艾司洛尔或 2 μg/ kg芬太尼预处理仅能部分减少插管反应 ,联合应用 2 mg/ kg艾司洛尔和 2 μg/ kg芬太尼能完全抑制高血压患者插管时的循环和儿茶酚胺反应。     

右美托咪啶对麻醉诱导双腔支气管内插管应激反应的影响

【目的】观察麻醉诱导前预注右美托咪啶对双腔支气管内插管患者应激反应的影响。【方法】本院59例全身麻醉下行肺或食管手术的患者,随机分为两组：对照组（C 组,n＝29）,试验组（D组,n＝30）,D组在诱导前接受静脉输注右美托咪啶（0．6μg/kg）,C组则静脉注射等量生理盐水。随后使用靶控输注丙泊酚,血浆靶浓度为3μg/mL,静脉注射舒芬太尼（0．3μg/kg）和顺阿曲库铵0．2 mg/kg,5 min后行双腔气管插管。分别在麻醉诱导前（T0）、气管插管后即刻（T2）抽血,采用高效液相色谱法检测血浆肾上腺素与去甲肾上腺素含量,观察并记录T0、气管插管前（T1）和T2平均动脉压（MAP）及心率（HR）变化。【结果】D组与 C组在 T0与T1时间点比较,MAP及HR没有明显变化（P＞0．05）;在T2,D组MAP与HR明显低于C组,且差异有显著性（P＜0．05）。两组肾上腺素水平和去甲肾上腺素水平T2均较麻醉诱导前明显增高;D组插管后肾上腺素水平和去甲肾上腺素水平明显低于C组,且差异有显著性（P ＜0．05）。【结论】麻醉诱导前预注入右美托咪定可有效降低双腔支气管内插管的应激反应,降低双腔气管插管后肾上腺素水平和去甲肾上腺素水平,可在麻醉诱导时辅助应用。     

不同剂量舒芬太尼对病人气管插管血流动力学的影响

目的比较不同剂量舒芬太尼复合异丙酚对病人气管插管血流动力学及脑电双频谱指数的影响,探讨舒芬太尼有效抑制气管插管应激反应的合适剂量。方法 60例择期全麻手术病人随机分为三组,每组20例,舒芬太尼剂量分别为0.2μg/kg（Ⅰ组）、0.3μg/kg（Ⅱ组）、0.4μg/kg（Ⅲ组）。3 min后三组均静脉注射异丙酚2 mg/kg和维库溴胺0.1 mg/kg麻醉诱导,经口气管内插管。记录麻醉诱导前（T0）、静脉注射舒芬太尼后（T1）、静脉注射异丙酚后（T2）、气管插管即刻（T3）、插管后3 min（T4）的收缩压（SBP）、舒张压（DBP）、心率（HR）、脑电双频谱指数（BIS）的变化。结果与T0比较,T1时三组SBP、DBP、BIS比较差异无统计学意义（P〉0.05）,T2时三组SBP、DBP、BIS明显下降（P（0.05或P（0.01）,T3时Ⅰ组SBP、DBP、BIS明显升高（P〈0.05）;与Ⅱ组比较,T3时Ⅰ组SBP、DBP、BIS明显升高（P〈0.05）;三组间各时点HR比较差异无统计学意义。结论应用舒芬太尼0.3μg/kg复合异丙酚2 mg/kg麻醉诱导能有效抑制气管插管应激反应,并维持插管期间血流动力学稳定,是临床使用的合理剂量。     

瑞芬太尼靶控输注对七氟醚抑制气管插管反应最低肺泡浓度ED50的影响

目的:研究瑞芬太尼(4ng/mL)靶控输注对七氟醚抑制气管插管反应最低肺泡浓度ED50的影响。方法:40例ASAⅠ级,择期妇科手术患者分为瑞芬太尼靶浓度4ng/mL+七氟醚吸入组(RS组,n=20),七氟醚吸入对照组(S组,n=20)。瑞芬太尼靶浓度和七氟醚呼出浓度稳定于预先设定值20min后行气管插管。七氟醚抑制气管插管反应最低肺泡浓度ED50测定方法采用医学序贯试验中的上～下法。结果:RS组七氟醚抑制气管插管反应最低肺泡浓度ED50为1.11%,95%可置区间为0.99%～1.24%;S组七氟醚抑制气管插管反应最低肺泡浓度ED50为4.59%,95%可置区间为4.21%～5.00%。结论:瑞芬太尼靶控输注可明显降低七氟醚抑制气管插管反应最低肺泡浓度ED50。     

依托咪酯和咪唑安定对不停跳冠状动脉旁路搭桥手术气管插管期间心率和血压影响的比较(英文)

Objective To compare the effect of etomidate and midazolam on heart rate and blood pressure during tracheal intubation in off-pump coronary artery bypass graft. Methods Sixty patients scheduled for coronary artery bypass graft surgery without cardiopulmonary bypass shunt were randomly and double-blindly divided into etomidate group (Group E,n=30) and midazolam group (Group M,n=30) based on the anesthetic used for induction.Electrocardiogram,systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR) and pulse oximetry saturation (SpO2) were measured and recorded continuously,as well as the value of rate-pressure product (RPP).The time used for tracheal intubation was also recorded.Results In Group M,compared with pre-tracheal intubation,the SBP and DBP of all patients decreased remarkably at the beginning of tracheal intubation (P<0.05).At 1 minute post-trachealintubation,the SBP,DBP and HR increased remarkably (P<0.01);meanwhile,the values of RPP were increased significantly than those at the beginning of tracheal intubation and pre-tracheal intubation (P<0.01).Compared with the values in Group E,at the beginning of tracheal intubation,the values of SBP and DBP in Group M were significantly decreased (P<0.05 and P<0.01,respectively),while the values of SBP,DBP and RPP at 1 minute after tracheal intubation were significantly increased (P<0.05 and P<0.01,respectively). Conclusions Compared with midazolam,etomidate used in anesthetic induction for coronary artery bypass graft surgery without cardiopulmonary bypass shunt may more effectively alleviate the cardiovascular responses to tracheal intubation.     

瑞芬太尼与芬太尼在小儿全麻诱导期的应用比较

目的：观察等效剂量瑞芬太尼和芬太尼诱导气管插管对小儿血流动力学的影响。方法：40例择期行全麻患儿随机分为瑞芬太尼组和芬太尼组,麻醉诱导使用咪唑安定0.15mg/kg、丙泊酚2.5mg/kg、芬太尼2.5μg/kg或瑞芬太尼2μg/kg和维库溴铵0.1mg/kg。分别于麻醉诱导前（T0）、诱导后2min（T1）、插管后1、2min（T2、T3）记录心率、收缩压和舒张压。结果：两组诱导前血流动力学指标相似。与T0时比较,两组患儿T1时收缩压、舒张压均降低（P〈0.05或P〈0.01）,心率均减慢（P〈0.05或P〈0.01）;瑞芬太尼组T2、T3时收缩压、舒张压降低（P〈0.05或P〈0.01）,心率减慢（P〈0.05）;芬太尼组T2、T3时收缩压、舒张压升高（P〈0.05）,心率增快（P〈0.05）。与芬太尼组比较,瑞芬太尼组T1、T2和T3时收缩压、舒张压均降低（P〈0.05）,心率减慢（P〈0.05）。结论：瑞芬太尼比等效剂量芬太尼能更好地抑制小儿全麻诱导气管插管时的心血管反应。     

BIS指导给药在重型颅脑损伤患者麻醉诱导阶段的应用

[目的]探讨在重型颅脑损伤(severe traumatic brain injury,STBI)患者的麻醉诱导阶段,脑电双频谱指数(bispectral index,BIS)指导下给药的应用价值.[方法]将52例STBI拟行手术治疗的患者随机分为观察组和对照组,每组26例.观察组依据BIS值给药诱导,静脉缓慢推注丙泊...     

Influence of hypercapnia on cardiovascular responses to tracheal intubation

Background

Laryngoscopy and tracheal intubation are often associated with tachycardia, hypertension, and arrhythmias. There is a risk of hypercapnia in the case of difficult mask ventilation. The circulatory response to hypercapnia is increases in arterial pressure and heart rate. We evaluated the difference of cardiovascular responses to tracheal intubation between normocapnia and hypercapnia during mask ventilation before tracheal intubation.

Methods

We studied 40 ASA physical status I to II patients under general anesthesia. Induction of anesthesia was achieved with midazolam 0.05 mg/kg, propofol 1.5 mg/kg, alfentanil 10 μg/kg, and rocuronium 0.6 mg/kg IV. The lungs were mechanically ventilated with a tidal volume of 10 mL/kg and 6 to 10 bpm in the hypercapnia group (n = 20) or 12 to 15 bpm in the normocapnia group (n = 20) during the induction period. Intubation was performed 3 minutes after the induction, and anesthesia was maintained using 1.5% sevoflurane (inspired) and 75% N₂O in oxygen. Heart rate, systolic arterial pressure (SAP), and diastolic arterial pressure were recorded every minute throughout the study.

Results

The proportion of the patients whose increase of SAP between just before intubation and 1 minute after intubation was more than 30 mm Hg in the hypercapnia group (40%) was greater than that in the normocapnia group (9.5%) (P = .0325). There were no differences in heart rate and diastolic arterial pressure between hypercapnia and normocapnia groups. For the SAP of the patients, the trend of changes was increased (P = .024).

Conclusions

Hypercapnia during mask ventilation before tracheal intubation may exaggerate the increase of SAP during intubation compared to normocapnia. Ventilation was important in minimizing hemodynamic responses during induction regardless of using drugs.     

Effects of ibuprofen on plasma endothelin levels and some vital parameters during endotoxin shock in rabbits.

BACKGROUND: There is evidence that septic shock results from breakdown in the balance between vasodilators such as prostacyclin, prostaglandin E(2), and nitric oxide, and the vasoconstrictors thromboxane A(2), serotonin, and endothelin. Increased plasma endothelin (ET) concentrations during septic shock were found. Inducing phospholipase A(2), ET causes release of arachidonic acid and production of prostaglandins. Ibuprofen is nonsteroidal anti-inflammatory drug inhibiting prostaglandin synthesis. There are no any information about the effects of ibuprofen on ET production in endotoxemia. In the present study we aimed to determine the effects of ibuprofen on plasma ET concentrations in an animal model of endotoxin shock. METHODS: A total of 28 rabbits were randomly allocated into four groups. The first group only received saline and served as controls. The rest of the animals (groups 2, 3, and 4) were injected intravenously with endotoxin at a dose of 2 mg/kg. To the third group, ibuprofen at 30 mg/kg dosage was given, 30 min following endotoxin administration, whereas in the fourth group animals, ibuprofen was administered 30 min before endotoxin administration. Animals were monitored through the canulation of femoral arteries and venules under the complete anaesthesia. At 0, 30, 60, 90, 120, 180, and 240 min, arterial blood pressure, heart rate, and ET determinations were carried out. RESULTS: Ibuprofen before the endotoxin administration was more effective in controlling the increase in heart rate. Ibuprofen was also effective in inhibiting the sudden reductions in blood pressure if administered before endotoxin. However, if administered after endotoxin injection, ibuprofen precipitated the reduction in blood pressure further. Ibuprofen reduced the ET production which was induced by the endotoxin administration. CONCLUSIONS: Ibuprofen administration during endotoxin shock seems to decrease the elevated ET concentrations, and increase the blood pressure.     

Effect of carbenoxolone on gastric prostaglandin E2 levels in patients with peptic ulcer disease following vagal and pentagastrin stimulation

The influence of oral carbenoxolone sodium (50 mg X 3 daily) on prostaglandin E2 release into gastric juice has been examined in nine peptic ulcer patients (duodenal ulcer, n = 6; prepyloric ulcer, n = 1; gastric ulcer, n = 2) during modified sham feeding and following bolus stimulation of acid secretion by pentagastrin (6 micrograms/kg). Carbenoxolone increased the overall mean of prostaglandin E2 concentrations in gastric juice following modified sham feeding by 32 +/- 9% (mean +/- SEM; P less than 0.02) and decreased the acidity slightly but significantly (P less than 0.05). A marked rise in prostaglandin E2 levels (46 +/- 11%; n = 5; P less than 0.02) was observed in for duodenal ulcer patients and the patient with a prepyloric ulcer responding to therapy (i.e., pain relief and ulcer healing within 4 weeks of treatment). A significant peak (P less than 0.05) related to modified sham feeding was observed only during medication, while a late gradual increase in prostaglandin E2 levels--not associated with vagal stimulation--occurred both in control and carbenoxolone experiments. No significant differences were observed following pentagastrin stimulation. The initial peak in prostaglandin E2 levels observed during medication favours the notion that the mechanism of drug action relies on inhibition of enzymatic degradation while the late increase in prostaglandin E2 levels may be explained by artificial prostaglandin formation during the aspiration procedure.     

Differential effects of propofol and sevoflurane on QT interval during anesthetic induction

There have been conflicting reports on whether propofol prolongs, shortens, or does not change QT interval. The aim of this study was to determine the effect of target-controlled infusion (TCI) of propofol on heart rate-corrected QT (QTc) interval during anesthetic induction. We examined 50 patients undergoing lumbar spine surgery. Patients received 3 μg/kg of fentanyl and were randomly allocated to one of the following 2 groups. Group S patients received 5 mg/kg of thiamylal followed by sevoflurane, 5 % at the inhaled concentration. Group P patients received propofol using TCI system at 5 μg/mL for 2 min followed by 3 μg/mL. Tracheal intubation was performed after vecuronium administration. Heart rate (HR), mean arterial pressure (MAP), bispectral index score (BIS), and QTc interval in 12-lead electrocardiogram were recorded at the following time points: just before fentanyl administration (T1), 2 min after fentanyl injection (T2), 1 min after thiamylal injection or 2 min after the start of TCI (T3), just before intubation (T4), and 2 min after intubation (T5). BIS and MAP significantly decreased after anesthetic induction in both groups. HR decreased after anesthetic induction and recovered after tracheal intubation in group P, whereas it did changed in group S throughout the study period. QTc interval was shortened at T3 and T4 in group P, but prolonged at T3, T4, and T5 in group S, as compared with T1. Propofol TCI shortens QTc interval, whereas sevoflurane prolongs QTc interval during anesthetic induction.     

DISCOPO内镜与McCoy喉镜在困难气道 清醒气管插管中的应用比较*

目的观察DISCOPO内镜与McCoy喉镜在困难气道清醒气管插管中的临床应用效果。方法将符合困难气道诊断标准的择期全麻下手术患者60例随机分为DISCOPO内镜组(D组)和McCoy喉镜组(M组),每组各30例,两组患者在表面麻醉与右美托咪定镇静的基础上,M组运用McCoy喉镜进行气管插管,D组使用DISCOPO内镜进行气管插管,记录两组患者气管插管所用时间、一次性气管插管成功率,声门暴露分级、插管并发症发生情况和围插管期血流动力学[血压(BP)和心率(HR)]变化。结果 D组气管插管时间短于M组(P 0.05),一次性插管成功率及声门暴露良好率明显高于M组(P 0.05),并发症发生率明显低于M组(P 0.05),D组T_2和T_3时间点BP和HR明显低于M组(P 0.05)。结论 DISCOPO内镜用于困难气道清醒插管用时短,成功率高,并发症少,值得临床推广应用。     

国产明视插管软镜与光棒在颈椎损伤患者气管插管中的应用比较*

目的比较国产明视插管软镜(VIS)与光棒(LW)用于颈椎损伤患者气管插管中的临床应用效果。方法颈椎损伤手术患者60例,随机分为国产明视插管软镜组(VIS组)和光棒组(LW组),每组30例。分别采用国产VIS和LW引导经口气管插管。记录两组气管插管时间、插管次数及成功率和插管相关并发症,观察两组麻醉前(T_1)、气管插管前(T_2)、气管插管后1 min(T_3)、气管插管后3 min(T_4)和气管插管后5 min(T_5)的平均动脉压(MAP)和心率(HR)。结果 VIS组气管插管时间(25.3±13.6)s,LW组气管插管时间(23.8±12.5)s,两组比较,差异无统计学意义(P0.05);两组患者一次气管插管成功率及总成功率比较,差异均无统计学意义(93.3%vs 93.3%,100.0%vs 100.0%,P0.05);与T_2时比较,T_3～T_4时两组患者MAP和HR均明显升高(P 0.05)。T_3～T_5各时点两组MAP和HR比较,差异均无统计学意义(P0.05)。两组气管插管相关并发症发生率比较,差异无统计学意义(10.0%vs 16.7%,P0.05)。结论国产VIS和LW均适用于颈椎损伤患者经口气管插管,气管插管时间短,成功率高,插管并发症少,对患者血流动力学影响较轻。     

不同剂量瑞芬太尼麻醉诱导剖宫产手术对母体与胎儿娩出的影响

【目的】比较不同剂量瑞芬太尼麻醉诱导剖宫产手术对母体与胎儿娩出的影响。【方法】选择有椎管内麻醉禁忌证的择期剖宫产手术患者60例,ASAⅠ～Ⅱ级,随机分为 A、B、C三组,每组20例,全身麻醉诱导采用丙泊酚1．5 mg/kg,维库溴铵0．1 mg/kg,瑞芬太尼分别为1．0μg/kg（A组）、1．5μg/kg （B组）、2．0μg/kg（C组）,辅助通气2 min后医生切皮开始手术,之后气管插管,进行机械通气,静脉输注瑞芬太尼0．15μg/（kg·min）,异丙酚4 mg/（kg·h）,间断静脉注入维库溴铵0．05 mg/kg维持麻醉。观察麻醉前（T0）、切皮即刻（T1）、气管插管即刻（T2）的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）、出血量、记录诱导至胎儿取出的时间（I～D时间）、1 min,5 min,10 min新生儿 Apgar评分以及新生儿的处理。【结果】三组患者麻醉前 SBP,DBP,MAP、HR组间比较无显著性差异（P＞0．05）。A组T1、T2分别与B和 C组的相同时间点比较 SBP,DBP,MAP、HR明显升高;同时 A组T1、T2与T0比较 SBP,DBP,MAP也明显升高,HR明显增加（P＜0．05）。B组和C组组间和组内比较均无显著性差异。出血量,I～D时间三组组间比较无显著性差异（P＞0．05）。1 min新生儿 Apgar评分C组与 A、B两组比较有显著性差异（P＜0．05）,5 min,10 min新生儿 Apgar评分三组组间比较无显著性差异（P＞0．05）。【结论】使用瑞芬太尼1．0μg/kg的诱导剂量,产妇血流动力学不稳定,而2．0μg/kg的诱导剂量,新生儿1min的Apgar评分下降,故1．5μg/kg瑞芬太尼用于剖宫产全身麻醉诱导效果良好,能较好的抑制术中产妇的应激反应,同时对新生儿无不良影响。     

异氟烷与丙泊酚麻醉对心脏手术后患者认知功能的影响

【目的】研究异氟烷、丙泊酚两种麻醉方法对体外循环(CPB)心脏手术患者术后认知功能的影响。【方法】60例CPB 心脏手术患者,年龄35~60岁,ASAⅡ~Ⅲ级,无严重肝肾功能受损和活动性炎症;随机分为丙泊酚全凭静脉麻醉组(P组)和异氟烷吸入麻醉组(I 组),每组30例。两组均采用依托咪酯0.3 mg/kg,舒芬太尼0.4~0.6μg/kg,咪达唑仑0.08~0.12 mg/kg,维库溴铵0.1 mg/kg 完成麻醉诱导,气管内插管后行机械通气。I 组以吸入异氟烷复合舒芬太尼、咪达唑仑、维库溴铵静注维持麻醉,吸入异氟烷呼气末浓度为1.5~2%。P 组用丙泊酚4~6 mg/kg/h 持续泵入复合舒芬太尼、咪达唑仑、维库溴铵静注维持麻醉。术前1 d,术后 d7、1个月用简易智力量表(MMSE)和数字广度对患者行神经心理学测试。【结果】①术后d7 I 组有9例发生了术后认知障碍(POCD),其 POCD 的发生率为30%,P 组 POCD 发生率为26.7%(8/30)。术后1个月 I 组POCD 的发生率为13.3%(4/30),P 组 POCD 的发生率为10%(3/10)。P、I 两组术后7 d、术后1个月 POCD 发生率相比较差异无显著性(P >0.05);②两组术后 MMSE 和数字广度得分无统计学差别。③患者转流时间和受教育程度与 POCD 有关,与年龄无关。【结论】①丙泊酚静脉麻醉和异氟烷吸入麻醉对患者术后认知功能的影响没有统计学差别。②POCD 与转流时间和受教育程度有关。     

艾司洛尔预处理对丙泊酚注射痛的影响

目的：观察小剂量艾司洛尔预处理对丙泊酚静脉注射痛的影响。方法：美国麻醉医师协会（ASA）分级为Ⅰ～Ⅱ级且择期行全麻手术的患者120例,随机分为3组,每组40例。经左前臂桡侧浅静脉置入20G套管留置针。麻醉诱导前左上臂包裹气压止血带,加压至70mmHg后,按分组以3mL/10s速度分别静脉注射：0.9%氯化钠液3mL（C组）,利多卡因0.5mg/kg（L组）,艾司洛尔0.25mg/kg（E组）,60s后松开止血带,将2mg/kg丙泊酚在20s内缓慢注入。随后静脉注射芬太尼、维库溴胺,行气管插管全麻。采用4分制记录3组患者丙泊酚注射痛评分,并记录药物预注前（T0）、气管插管前（T1）、气管插管后1min（T2）、气管插管后3min（T3）的平均动脉压（MAP）和心率（HR）。结果：注射痛的发生率C组为65%（26/40）,而L组为10%（4/40）,E组为25%（10/40）,与C组相比显著降低（P〈0.01）。L组和E组中度和重度疼痛的发生率均显著低于C组（P〈0.05和P〈0.01）。E组与L组比较,差异无统计学意义（P〉0.05）。结论：小剂量艾司洛尔预处理合用止血带可有效缓解丙泊酚注射痛。     

瑞芬太尼复合丙泊酚用于患者清醒状态下气管插管的临床研究

目的研究丙泊酚复合瑞芬太尼用于患者清醒状态下实施气管插管的可行性,以及插管过程中,插管操作对血压、心率等生命体征的影响。方法选取2012年12月-2013年4月美国麻醉医师协会分级Ⅰ～Ⅱ级、施行全身麻醉手术患者80例,将其随机分为两组。A组为芬太尼丙泊酚组;B组为瑞芬太尼-丙泊酚-利多卡因组;两组患者性别、年龄、体质量等一般资料比较差异无统计学意义（P〉0.05）。A组患者采用常规诱导插管方法：给予咪达唑仑0.05～0.10 mg/kg,芬太尼4μg/kg,丙泊酚1.0～1.5 mg/kg,阿曲库铵0.6～0.9 mg/kg,肌肉松弛后行气管插管。B组患者采用瑞芬太尼-丙泊酚-利多卡因复合液缓慢静脉泵注,复合环甲膜穿刺的方法行气管插管。观察两组患者诱导前后生命体征变化和呛咳反应发生情况。结果两组患者均能顺利完成气管插管,A组患者循环改变以及心动过速的发生率明显高于B组（P〈0.05）。两组患者心动过缓、低氧血症及呛咳反应发生率均低,差异无统计学意义（P〉0.05）。结论瑞芬太尼-丙泊酚-利多卡因复合液能够安全用于患者清醒状态下实施气管插管,血流动力学稳定,具有临床推广价值。     

罗库溴铵对风湿性心脏病患者心肌供氧和耗氧量的影响

目的：在风湿性心脏病患者瓣膜置换术中,评价罗库溴铵在麻醉诱导期间对患者心肌氧供和氧耗平衡的影响。方法：选择86例在中低温体循环下行瓣膜置换术的患者,采用随机双盲法分配成罗库溴铵组（n=42例）和维库溴铵组（n=41例）。给予咪唑安定（0.05～0.1mg/kg）及芬太尼（10～15μg/kg）及等效剂量的罗库溴铵0.6mg/kg或维库溴铵0.1mg/kg（Org.Comp）进行麻醉诱导。监测麻醉诱导前至插管后10分钟（1次/1分）期间两组患者心肌氧供和氧耗的变化。结果：与基础值相比,罗库溴铵组患者在插管后5分钟期间心率增加了17.4%～13.5%,动脉收缩压增加了16.94%～14.3%,平均动脉压增加了15.1%～13.2%。同期心率收缩压乘积增加了22.67%～13.96%（P〈0.05）。心率和动脉血压在插管后1～7分钟期间明显高于同期的维库溴铵组患者（P〈0.05）。结论：在ASAⅢ-Ⅳ级、心功Ⅱ-Ⅲ级风心病瓣膜病变患者进行瓣膜置换术中,0.6mg/kg罗库溴铵有潜在增加患者心肌耗氧量的作用。