尼卡地平或复合艾司洛尔预防气管插管时心血管反应的效果

本文比较单独应用尼卡地平或尼卡地平复合艾司洛尔在预防气管插管心血管反应的效果 ,为临床降低麻醉应激反应提供参考。资料与方法一般资料　选择 40例择期胸外科手术病人 ,ＡＳＡⅠ～Ⅱ级 ,随机分为Ａ组 (ｎ =2 0 )和Ｂ组 (ｎ =2 0 ) ,术前无心血管系统病史。麻醉方法　麻醉前 1小时肌注地西泮 0 2ｍｇ/ｋｇ、阿托品 0 5ｍｇ。诱导前 2分钟Ａ组静注盐酸尼卡地平针剂2 0 μｇ/ｋｇ(山之内制药株式会社 ,批号 980 90 4Ａ) ,Ｂ组静注尼卡地平 10 μｇ/ｋｇ +艾司洛尔 0 5ｍｇ/ｋｇ(齐鲁制药厂 ,批号970 30 0 2 )。诱导药为依托咪酯 0 3ｍ…     

尼卡地平伍用芬太尼减轻气管插管时心血管副反应的研究

３６例ＡＳＡＩ级择期手术患者，随机分为三组，每组１２例。全麻诱导均静脉注射硫喷妥钠８ｍｇ／ｋｇ和琥珀胆碱２ｍｇ／ｋｇ．诱导前５分钟组Ｉ静注生理盐水４ｍｌ，组Ⅱ静注尼卡地平０．０１ｍｇ／ｋｇ，组Ⅲ静注尼卡地平０．０１ｍｇ／ｋｇ和芬太尼３μｇ／ｋｇ。结果显示组Ⅲ在插管后ＳＢＰ、ＨＲ和ＲＰＰ变化最小。表明静注尼卡地平０．０１ｍｇ／ｋｇ和芬太尼３μｇ／ｋｇ是减轻气管插管时心血管副反应的有效方法。     

尼卡地平预注对高血压患者气管插管心血管反应的预防作用

高血压患者全身麻醉诱导期间应重视如何预防或减轻气管插管时的心血管反应[1]。据报告尼卡地平能有效预防正常血压患者的气管插管反应[2,3]。本文目的是观察尼卡地平预防高血压患者气管插管心血管反应的效果。资料与方法18例ＡＳＡⅡ～Ⅲ级术前有高血压、行择期手术患者,随机均分为Ａ、Ｂ两组。两组患者的性别、年龄、体重、术前病情无明显差异(Ｐ>005)。高血压的诊断参照ＷＨＯ高血压诊断标准:ＳＢＰ≥213ｋＰａ和/或ＤＢＰ≥127ｋＰａ。10例有原发性高血压2～10年,口服硝苯吡啶、卡托普利、依那普利、复方降压片等治疗。术前血压控制在220…     

艾司洛尔、乌拉地尔或尼卡地平预防气管插管时心血管反应的临床观察

全麻诱导后喉镜窥视和气管插管可引起ＨＲ加快、ＢＰ升高等心血管反应。如何控制和降低气管插管引起的心血管反应是临床麻醉医师关注的问题之一。本研究通过比较诱导前预先静脉注射艾司洛尔 (ｅｓｍｏｌｏｌ)、乌拉地尔 (ｕｒａｐｉｄｉｌ,ＵＲＡ)或尼卡地平 (ｎｉｃａｒｄｉｐｉｎｅ)三种药物后插管期间ＢＰ和ＨＲ的变化 ,试以评价其预防心血管反应的效果 ,指导临床麻醉。资料与方法一般资料　 48例ＡＳＡⅠ级择期手术患者 ,男 2 3例 ,女2 5例 ,年龄 2 0～ 5 5岁 ,体重 45～ 70ｋｇ ,全部病例术前ＢＰ、ＨＲ、心电图和电解质均正常。麻醉方…     

尼卡地平、艾司洛尔预防气管拔管反应的临床研究

目的:观察尼卡地平、艾司洛尔预防气管拔管反应的效果。方法:选择48例择期胆囊结石手术病人,ASAⅠ～Ⅱ级为观察对象,随机分成4组。A组:15μg·kg~(-1)尼卡地平;B组:1mg·kg~(-1)艾司洛尔;C组:给予15μg·kg~(-1)尼卡地平复合1mg·kg~(-1)艾司洛尔;D组:生理盐水组。结果:4组病人年龄、体重、手术时间、麻醉时间、手术方式及用药前血压、心率均无显著性差异(P>0.05)。A组:用药后1～3分钟,MAP与D组有显著性差异(P<0.01);B组:HR用药后及拔管后与D组有显著性差异(P<0.01);C组:MAP及HR与D组相比有显著性差异(P<0.01)。结论:尼卡地平复合艾司洛尔可以较好地预防围拔管期心血管反应。     

预防气管插管时心血管反应的进展

喉镜窥视和气管插管可引起显著的血压升高、心率加快等循环系统副反应。抑制这一反应的方法很多,本文就近年来的进展概述如下。α和β受体阻滞药安替洛尔(Atenolol)β受体阻滞药,并拮抗儿茶酚胺效应。口     

应用芬太尼、乌拉地尔预防老年患者气管插管时的心血管反应

在气管插管前应用小剂量芬太尼和乌拉地尔预防心血管副反应，对２０例老年患者作了对比观察，临床组和对照组各１０例。结果表明，临床组气管插管后血流动力学较稳定。对照组血流动力学反应较明显。提示小剂量芬太尼、乌拉地尔可有效地抑制老年患者气管插管时的心血管反应。     

伍用前列腺素E1和芬太尼预防气管插管时的心血管反应

喉镜窥视和气管插管时常引起心血管副反应,目前预防的方法虽很多,我们选择40例病人,在插气管导管前先静注前列腺素E_1和小剂量芬太尼对比观察其效果,现报道如下。 资料和方法 40例择期全麻下剖腹手术病人。ASAⅠ～Ⅱ级,均无高血压病史,心电图、血常规、x线及肝肾功能检查均在正常范围。此40例病人随机分为两组(试验组和对照组),每组20例。两组年龄(51.00±14.36岁、     

小剂量芬太尼麻醉诱导抑制气管插管时心血管反应最佳时间的观察

本文报道了麻醉诱导时静注小剂量芬太尼不同时相行气管插管的循环反应情况。资料与方法1 0 0例择期全麻手术病人 ,ＡＳＡⅠ～Ⅱ级。随机分为五组 ,每组 2 0例 ,第Ⅰ组为对照组 ,诱导用药为硫喷妥钠 5ｍｇ/ｋｇ 阿曲库铵 0 5ｍｇ/ｋｇ,给药时间共用 60秒 ,4分钟后行气管插管 ;     

异丙酚静注预防气管插管时的心血管副反应

在全身麻醉诱导时,我们使用异丙酚预防气管插管的心血管反应,并与硫喷妥钠进行比较观察,现报告如下。临床资料和方法 40例胸腹部择期手术病人,男27例,女13例,年龄35～60岁,体重45～68kg。ASAⅠ～Ⅱ级,术前心血管、呼吸和肝肾功能均正常。随机分成两组,每组20例。两组年龄、性别和体重无明显差异。均在术前     

光导纤维喉镜用于气管插管时循环系统的变化

３０例外科手术病人，分为三组。Ⅰ组为普通喉镜顺利气管插管，Ⅱ组为光导纤维喉镜顺利插管组，Ⅲ组为光导纤维喉镜困难插管组。结果表明：三组病人插管时均可引起剧烈的心血管反应，但变化幅度以Ⅲ组最大，本文提示，与普通喉镜相比，光导纤维喉镜和于并无困难插管的病人引起的心血管反应相似，而用于困难插管的病人也可产生严重的心血管反应，可能与插管困难的病人暴露困难致使插管时间较长或刺激强度增大有关。     

异搏定及硫酸镁预防气管插管所致心血管不良反应的临床研究

观察异搏定或硫酸镁缓解气管插管所致不良心血管反应的作用，结果表明，静脉注射异搏定５ｍｇ后快速诱导插管，麻醉诱导后动脉收缩压和舒张压均下降（Ｐ＜０．０５），气管插管后各时相动脉血压未升高，反而下降并有极显著性意义（Ｐ＜０．０１），插管后１ｍｉｎ心率增快（Ｐ＜０．０５）。静脉注射硫酸镁（６０ｍｇ／ｋｇ）后麻醉诱导插管，麻醉诱导后动脉收缩压及舒张压下降（Ｐ＜０．０５），气管插管后各时相动脉收缩压与舒张压     

清醒健忘式诱导气管插管术

本文采用清醒健忘诱导、常规快速诱导两种方法,通过监测诱导前后的呼吸、心率、血压、动脉血气分析并进行对比研究。结果:两组诱导前的血压、心率比较无差异(P>0.05),清醒健忘诱导组诱导前后心率、血压比较无明显差异(P>0.05):而快速诱导法组诱导前后血压、心率变化明显(P<0.01)。氟哌啶、芬太尼、安定伍用镇痛作用强,睡眠作用浅,下颌松弛好,又有健忘,且对心血管扰乱小。结论:清醒健忘诱导法适用于心功能低下、饱餐以及气管插管困难的病人,也适用于需经气管内插管氧治疗的呼吸功能不全的病人。     

气管插管有关问题 咪唑安定在全麻诱导气管插管期间血流动力学变化的观察

本文采用无创心功能自动检测仪观察咪唑安定全麻诱导气管插管期间血流动力学变化,并与硫喷妥钠比较。15例病人随机分为两组,均先静注哌替啶50mg、异丙嗪25mg,I组静注咪唑安定0.3mg/kg,潘库溴铵0.1mg/kg,Ⅱ组静注硫喷妥钠5mg/kg、潘库溴铵0.1mg/kg。结果表明,咪唑安定可以增加心排血量,轻度减轻后负荷,不影响心肌收缩力和前负荷。故对缺血性心脏病、低心排血量的患者全麻诱导时,咪唑安定较硫喷妥钠安全可靠。对气管插管反应,咪唑安定仍不能有效的防止,但较硫喷妥钠反应轻微。     

潘库溴铵预注气管插管影响因素的综合分析

ASA Ⅰ～Ⅱ级择期全麻手术18例,男14,女4,用潘库溴铵预注法诱导插管,应用正交试验L_(18)(3~7)方法,观察0.01、0.015、0.02mg/kg三种不同水平的预注量(PD);4、5、6min预注时间(PI)及0.08、0.10、0.12mg/kg插管剂量(ID)对预注效果的影响,求出影响预注效果的最主要因素和每个因素的最佳水平从而提出合理的预注模式。本研究得出:ID是最主要因素;PD 0.02mg/kg、PI 6min、ID 0.12mg/kg是潘库溴铵预注的最佳模式。另选全麻手术5例,用该模式预注观察,证明本研究结果基本可靠。     

Video-Assisted Versus Conventional Tracheal Intubation in Morbidly Obese Patients

Background  We compared tracheal intubation characteristics and arterial oxygenation quality during airway management of morbidly obese patients whose trachea was intubated under video assistance with the LMA CTrach™ (SEBAC, Pantin, France) or the Airtraq™ laryngoscope (VYGON, écouen, France) with that of the conventional Macintosh laryngoscope. Methods  After standardized induction of anesthesia, 318 morbidly obese patients scheduled for elective morbid obesity surgery received tracheal intubation with the LMA CTrach™, the Airtraq™ laryngoscope, or the conventional Macintosh laryngoscope. Duration of apnea, time to tracheal intubation, and oxygenation quality during airway management were compared between the LMA CTrach™ and the laryngoscope groups. Results  Patients’ characteristics were similar in the three groups. The success rate for tracheal intubation was 100% with the LMA CTrach™ and the Airtraq™ laryngoscope. One patient of the Macintosh laryngoscope group received LMA CTrach™ intubation because of early arterial oxygen desaturation associated with unstable facemask ventilation. The duration of apnea was shorter with the LMA CTrach™ than that of the Airtraq™ laryngoscope and the Macintosh laryngoscope. The duration tracheal intubation was shorter with the Airtraq™ laryngoscope than with the Macintosh laryngoscopes and the LMA CTrach™. During airway management, arterial oxygenation was of better quality with the LMA CTrach™ and the Airtraq™ laryngoscope than that of the Macintosh laryngoscope. Conclusion  Because LMA CTrach™ promoted short apnea time and the Airtraq™ laryngoscope allowed early definitive airway, both video-assisted tracheal intubation devices prevented most serious arterial oxygenation desaturation evidenced during tracheal intubation of morbidly obese patients with the conventional Macintosh laryngoscope. Support was provided solely from department sources. LMA and PRODOL Companies promoted material support for the airways.     

Effect of Combinations of Topical Anaesthesia, Fentanyl, Halothane or N2O on Circulatory Intubation Response in Normo- and Hypertensive Patients

Attenuation of the circulatory intubation response was studied using the following combinations: oropharyngeal topical anaesthesia (OTA) + fentanyl 2μg/kg (F2), OTA+2% halothane with 70% nitrous oxide (H2N₂O) or F₂ + H2N₂O. Firstly, it was observed in 48 normotensive patients that the combinations of OTA + F₂ or F₂ + H2N₂O totally prevented the intubation response; OTA + H2N₂O, on the other hand, was less effective. Secondly, the effect of OTA+F₂ was studied in 26 hypertensive patients and their 26 normotensive controls of the same age group. The combination prevented the circulatory intubation response also in the hypertensive patients, whose circulatory reactions did not differfrom those of the normotensive patients. Nitrous oxide had no beneficial effect on the intubation response.     

Cardiovascular Response to Endotracheal Intubation During Four Anesthetic Techniques

In order to investigate the impact of four different anesthetic regimens on the cardiovascular response to endotracheal intubation, 24 patients were anesthetized to approximately the same depth of anesthesia (MAC-fraction) using one of four supplements to N2O-O2 (60:40) anesthesia: Group 1 = morphine 0.5 mg/kg i.v., Group 2 = Innovar 0.1 ml/kg i.v., Group 3 = halothane, 0.4% end-tidal, Group 4 = enflurane 0.7% end-tidal. Cardiovascular variables were recorded from radial arterial and thermistor-tipped pulmonary artery catheters and were determined at the following times: (1) while the patients were awake prior to induction of anesthesia; (2) after a stable level of anesthesia had been induced; and (3) within the first minute after endotracheal intubation. Only the groups receiving morphine and halothane sustained significant increases in heart rate, rate pressure product and pulmonary capillary wedge pressure after intubation. It is concluded that N2O-O2 anesthesia supplemented with either morphine or halothane at the 1 MAC dose level does not adequately prevent cardiovascular response after endotracheal intubation, and that these techniques require additional anesthetic depth or other adjuvant drugs in order to prevent cardiovascular complications.     

Effects of double administration of nicardipine of the cardiovascular response to tracheal intubation in hypertensive patients

The efficacy of intravenous nicardipine in attenuating the cardiovascular responses to laryngoscopy and tracheal intubation was studied in 20 hypertensive patients. Ten patients received intravenous 1 mg of nicardipine 1 min before induction (N1 group). The other ten received 1 mg of nicardipine 1 min before induction and an additional 1 mg just before laryngoscopy (N2 group). In the N1 group, arterial pressure and heart rate increased significantly after tracheal intubation. In the N2 group, arterial pressure did not increase but heart rate increased more than that in N1 group. There was no significant difference in rate pressure product between the two groups.