前列腺素E1预防全麻气管内插管心血管副反应的观察

目的 为探讨前列腺素Ｅ１（ＰＧＥ１）预防全麻气管内插管所致心血管副反应的临床效果及作用机理。方法 ６０例ＡＳＡＩ～Ⅱ级择期手术患者随机分为三组,每组２０例,Ｉ组（ＰＧＥ１组）于气管内插管前１５－２０秒静脉注射前列腺素Ｅ１０．５μｇ／ｋｇ,Ⅱ组（表面麻醉组）于气管内插管前１０分经环甲膜和气管内注射１％丁卡因２．５ｍｌ,Ⅱ组（对照组）。三组均以芬太尼,硫喷妥钠,琥珀胆碱静脉诱导后行气管内插管,于诱导前     

不同速率输注瑞芬太尼对老年患者气管插管反应的影响

目的评价不同速率输注瑞芬太尼对老年患者气管插管反应的影响。方法 30例择期行上腹部手术老年患者,随机分为3组(n=10),麻醉诱导开始时,分别静脉输注瑞芬太尼0．05μg· kg-1·min-1(R0．05组)、0．10μg·kg-1·min-1(R0．10组)、0．15μg·kg-1·min-1(R0．15组),10 min后静脉注射咪唑安定0．1 mg·kg-1,意识消失后静脉注射琥珀酰胆碱1．5 mg·kg-1,行气管插管,于输注瑞芬太尼前、气管插管前即刻、气管插管后即刻、气管插管后2、5、10min记录血压(BP)、心率(HR),并于各时点采静脉血检测肾上腺素(E)、去甲肾上腺素(NE)水平;记录各组肌僵、低血压等副反应的发生情况。结果 R0．05组气管插管反应的发生率(80％)高于R0．10组(10％)和R0．15组(10％)。R0．15组肌僵、血压下降和心动过缓等副反应的发生率高于R0．10组。R0．05组气管插管后2、5、10 min及R0．10 组气管插管后2、5 min NE、E浓度均高于基础值,且高于R0．15组;R0．15组气管插管后2、5 min NE浓度高于基础值,E浓度差异无统计学意义。结论老年患者静脉输注瑞芬太尼诱导气管插管的合适速率为0．10μg·kg-1·min-1。     

Effect of buprenorphine on the cardiovascular response to tracheal intubation

The effects of buprenorphine on the haemodynamic responses to tracheal intubation were studied in a placebo-controlled double-blind trial in 40 patients who had elective surgery. In one group saline was administered intravenously 8 minutes before induction, whereas the others received buprenorphine 2.5 micrograms/kg intravenously. Anaesthesia was induced in both groups with thiopentone 4 mg/kg followed by suxamethonium 1.5 mg/kg after 90 seconds. In the buprenorphine group, the maximum increase in systolic and diastolic arterial blood pressures, heart rate and rate pressure product were significantly lower compared to the control group. It is concluded that buprenorphine is partially effective in attenuating the cardiovascular response to laryngoscopy and intubation, but does not obliterate it.     

The effect of sufentanil on the cardiovascular responses to tracheal intubation

The effects of sufentanil 0.5 or 1 microgram/kg, given intravenously after induction of anaesthesia, on the cardiovascular responses to tracheal intubation were examined in a controlled, randomised, double-blind investigation. The control group of patients exhibited significant rises in arterial blood pressure and heart rate for 4 minutes after tracheal intubation. Heart rate exceeded 100 beats/minute and systolic pressure increased by over 20% in every patient. All patients moved or breathed within 10 minutes of the administration of suxamethonium. Sufentanil 0.5 microgram/kg prevented increases in the mean values of heart rate and arterial blood pressure, although increases were observed in five patients. Significant falls in the mean values of heart rate and arterial pressure occurred from 4 minutes after intubation until observations ended 15 minutes after induction of anaesthesia. Two patients moved or breathed during this time, although movement in response to nerve stimulation occurred in all patients 10 minutes after administration of suxamethonium. Sufentanil 1 microgram/kg was effective in suppressing a rise in heart rate or arterial pressure in every patient. Significant falls in these variables occurred from 2 minutes after tracheal intubation onwards. No patient moved or breathed for 15 minutes after induction of anaesthesia, although neuromuscular transmission was present 10 minutes after giving suxamethonium in each case.     

异丙酚麻醉诱导期间不同剂量瑞芬太尼对病人气管插管心血管反应的影响

目的比较异丙酚麻醉诱导期间不同剂量瑞芬太尼对病人气管插管心血管反应的影响，寻找瑞芬太尼复合异丙酚气管插管的合适剂量。方法择期行腹腔镜胆囊切除术病人36例，ASAⅠ或Ⅱ级，年龄20～65岁，随机分为3组（n=12）：瑞芬太尼1、1．5、2μg／kg分别为复合异丙酚1．5μg／kg组（Ⅰ、Ⅱ、Ⅲ组）。依次静脉注射咪唑安定0．03mg／kg、异丙酚1．5mg/kg、维库溴铵0．1mg／kg以及瑞芬太尼麻醉诱导，2min后气管插管，进行机械通气，呼吸频率12次／min，潮气量8～10ml／kg，维持呼气末二氧化碳分压35～45mmHg。持续监测血压（平均动脉压、舒张压、收缩压）、心率（HR）以及听觉诱发电位指数（AAI），并记录病人有无气管插管时呛咳和肌肉强直、术中知晓等反应。结果与基础值比较，三组气管插管前即刻血压及Ⅲ组气管插管后即刻舒张压均降低，Ⅲ组气管插管后即刻血压低于Ⅰ组（P〈0．05）；HR组间及组内比较差异无统计学意义；三组间AAI差异无统计学意义。结论异丙酚1．5mg／kg麻醉诱导期间瑞芬太尼1或1．5μg／kg是病人气管插管时的合适剂量。     

舒芬太尼复合艾司洛尔对全麻患者气管插管时心血管反应的影响

目的评价舒芬太尼复合艾司洛尔对全麻患者气管插管时心血管反应的影响。方法择期上腹部手术患者60例,年龄26～50岁,体重48～75kg,ASAⅠ或Ⅱ级,随机分为3组（n=20）：舒芬太尼0.5μg/ks组（Ⅰ组）、芬太尼5μg/kg＋艾司洛尔1 mg/kg组（Ⅱ组）和舒芬太尼0.5μg/kg＋艾司洛尔1 mg/kg组（Ⅲ组）。3组均静脉注射试验用药、异丙酚1.5 mg/kg和维库溴铵0.1 mg/kg麻醉诱导后气管插管,机械通气。分别于麻醉诱导前（T1）、麻醉诱导后1min（T2）、气管插管后即刻（T3）、气管插管后1 min（T4）、3min（T5）及10min（T6）记录HR,收缩压（SP）、舒张压（DP）,并于T1、T2、T4时采集桡动脉血7 ml,测定血浆肾上腺素（Ad）和去甲肾上腺素（NA）的浓度。结果与Ⅰ组比较,Ⅱ组和Ⅲ组HR、SP、DP及血浆Ad和NA的浓度降低（P〈0.05）;与Ⅱ组比较,Ⅲ组HR、SP、DP降低（P〈0.05）。与T1比较,T2时3组HR、SP、DP及血浆Ad和NA浓度降低（P〈0.05）,Ⅰ组T3时HR、SP、DP升高,T4时HR升高,Ⅱ组、Ⅲ组差异无统计学意义（P〉0.05）。结论舒芬太尼0.5μg/kg复合艾司洛尔1mg/kg可更好地预防全麻患者气管插管时的心血管反应。     

不同剂量右美托咪啶抑制气管插管诱发患者心血管反应效应的比较

目的 比较不同剂量右美托咪啶抑制气管插管诱发患者心血管反应的效应.方法 拟在全麻下行择期上腹部手术患者120例,年龄18～60岁,体重45～80 kg,ASA分级Ⅰ或Ⅱ级,随机分为4组(n=30):对照组(C组)、低、中、高剂量右美托咪啶组(M1～3组),分别在麻醉诱导前15 min静脉输注15 ml生理盐水、右美托咪啶0.25、0.50和1.00μg/kg,输注时间15 min.麻醉诱导后,BIS值≤60并维持5 s时行气管插管后机械通气.于输注右美托咪啶前(T0)、气管插管前(T1)、气管插管即刻(T2)、气管插管后1、3、5、10 min(T3～6)时记录BP和HR;颈内静脉采血,测定血浆肾上腺素(E)、去甲肾上腺素(NE)浓度.结果 与T0时比较,T1时M1～3组HR降低、M3组BP升高,T4～6时C组和M1组血浆E和NE浓度升高(P＜0.05);与T1时比较,C组和M1组T2时BP和HR降低,T3～5时BP和HR升高(P＜0.05);T1～6时M3组较M2组BP升高(P＜0.05).结论 静脉输注右美托咪啶剂量达0.5μg/kg时,可显著抑制伤害性刺激诱发的应激反应.     

不同剂量瑞芬太尼对患儿经口气管插管血液动力学反应的影响

目的探讨不同剂量瑞芬太尼对患儿经口气管插管血液动力学反应的影响。方法择期在全身麻醉下行整形外科手术患儿120例，ASAⅠ级或Ⅱ级，年龄3～9岁，体重13～35kg，随机分为4组，每组30例，对照组（C组）麻醉诱导时复合应用生理盐水0．2ml／kg，R1组、R2组和R3组麻醉诱导时分别复合应用瑞芬太尼0．75、1、1．25μg/kg。均采用直接喉镜行经口气管插管。记录麻醉诱导前（基础值）、麻醉诱导后、气管插管时、气管插管后1、2、3、4、5min时的BP、HR。计算收缩压（SP）与心率（HR）的乘积（RPP），记录各组SP、HR变化幅度高于基础值30％、RPP〉22000的发生情况及气管插管后至SP、HR恢复到插管前的时间。结果与基础值比较，麻醉诱导后4组BP降低，C组、R1组HR升高，R2组、R3组HR及RPP降低，气管插管时4组HR升高，C组、R1组及R2组BP、RPP升高。与C组比较，R1组、R2组及R3组BP、HR及RPP降低（P〈0．05）；与R1组比较，R2组HR和RPP降低，R3组BP、HR和RPP降低（P〈0．05）；R2组和R3组差异无统计学意义（P〉0．05）。结论患儿麻醉诱导时复合应用瑞芬太尼可预防直接喉镜经口气管插管血液动力学反应，瑞芬太尼1μg／kg为推荐剂量。     

Effects of beta-adrenoceptor antagonism on the cardiovascular and catecholamine responses to tracheal intubation

The catecholamine and cardiovascular responses to laryngoscopy and tracheal intubation were studied in 20 patients who underwent elective gynaecological surgery and who were allocated randomly to receive either practolol 10 mg or saline intravenously prior to induction of anaesthesia. Anaesthesia was induced with fentanyl and thiopentone; atracurium was administered and the lungs were ventilated artificially with 67% nitrous oxide in oxygen. Tracheal intubation was performed when muscle relaxation was adequate. Arterial pressure, heart rate, plasma noradrenaline and adrenaline concentrations were measured before and after tracheal intubation. A significant increase in catecholamine concentrations occurred in both groups in response to tracheal intubation but the magnitude of the increase in adrenaline was greater in the practolol group. There were no significant differences in arterial pressure or heart rate changes between the groups. We conclude that pretreatment with practolol is of no value in the attenuation of the hypertensive response to direct laryngoscopy and tracheal intubation in previously normotensive patients.     

异丙酚、硫喷妥钠预防气管插管危险性的临床随机对照研究

目的 比较异丙酚与硫喷妥钠预防拨管插的危险性的效果。方法 选择全麻气管插管手术病人２２４例，观察异丙酚２．０ｍｇ／ｋｇ复合芬太尼２μｇ／ｋｇ的气管插管危险性，并采用多因素分析与硫喷妥钠５．０ｍｇ／ｋｇ复合芬太尼２μｇ／ｋｇ进行比较。结果 硫喷妥钠组不率为８５．５９％，异丙酚组为８１．４２％，组间无显著性差异（Ｐ〉０．０５），除外低血压症，硫喷妥钠组不满意率为７９．２８％，异丙酚分别为４５．１３％，     

Landiolol attenuates the cardiovascular response to tracheal intubation

Purpose The objective of this prospective study was to compare the cardiovascular responses with or without landiolol to the induction of general anesthesia and tracheal intubation. Methods Twenty-two patients were randomly allocated to receive a loading dose of landiolol 125 μg kg⁻¹ min⁻¹ for 1 min followed by an infusion at 40 μg kg⁻¹ min⁻¹ for 4 min, or placebo. Four minutes after landiolol or placebo was started, propofol and succinylcholine were administered. Laryngoscopy and tracheal intubation were performed 1 min after the administration of succinylcholine. Heart rate and blood pressure were measured noninvasively every minute. Results A significant attenuation of the heart rate and blood pressure response were seen in the landiolol group for 3 min after intubation. Heart rate and systolic blood pressure in the landiolol group were decreased for 2 min before intubation and just before intubation compared with baseline, srespectively. Conclusion Continuous administration of landiolol before tracheal intubation results in the attenuation of cardiovascular response for tracheal intubation.     

阿芬太尼和艾司洛尔对气管插管时循环和儿茶酚胺反应的影响

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卡托普利对气管插管时循环血中一氧化氮/内皮素平衡的影响

目的 探讨气管插管时循环血中一氧化氮/内皮素(NO/ET)平衡的变化及卡托普利对其的影响。方法 择期手术病人30例随机分为两组各15例,A组为卡托普利组,B组为对照组。两组均以氟哌啶、芬太尼、硫喷妥钠、氯化琥珀胆碱诱导插管。分别于诱导前、插管即刻、插管后1～1.5min、5min测定血浆NO、ET的浓度及平均动脉压(MAP)、心率(HR)。结果A组插管期间MAP、HR及ET无明显变化(P>0.05),血清NO含量于插管即刻及其后1～1.5min和NO/ET比值于插管即刻较诱导前均显著升高(P<0.05或0.01)。B组插管时及其后MAP、HR及ET明显增高(P<0.05或0.01),插管时及其后NO和NO/ET比值较诱导前明显降低(P<0.05或0.01)。与B组相比,A组插管时及其后1～1.5min的MAP、HR显著降低(P<0.01),插管后1～1.5min的ET显著降低(P<0.05),而NO于插管即刻及NO/ET于插管时及其后显著增高(P<0.05或0.01)。结论 气管插管心血管副反应期间循环血中NO与ET失衡,使NO/ET比值降低;卡托普利可改善NO/ET的失衡,并使NO/ET比值增加,有利于插管期间血液动力学的稳定。     

Partial attenuation of the cardiovascular responses to tracheal intubation with oral manidipine

We conducted a placebo–controlled, randomized, and double–blinded study to evaluate the efficacy of manidipine given orally in attenuating the cardiovascular responses to laryngoscopy and tracheal intubation. Thirty normotensive patients (ASA physical status 1) undergoing elective surgery were allocated to one of three groups (n= 10 for each); placebo, 5 mg manidipine, and 10 mg manidipine groups. These tablets were orally administered 3 h before induction of anaesthesia. Anaesthesia was induced with thiopentone 5 mg kg^-1 iv , and tracheal intubation was facilitated with vecuronium 0.2 mg–kg^-1. Laryngoscopy lasting 30 sec was attempted 2 min after induction of anaesthesia. Patients receiving placebo showed a significant increase in systolic and diastolic blood pressure associated with tracheal intubation. These increases following tracheal intubation were significantly reduced in patients receiving manidipine 10 mg compared with patients receiving placebo or manidipine 5 mg ( P < 0.05). Oral administration of manidipine 10 mg before induction of anaesthesia is a simple and effective method for attenuating pressor response to laryngoscopy and tracheal intubation. We stressed that the potential beneficial effect of a reduced haemodynamic reaction to intubation might be obtained at the expense of hypotension later on.     

Blood pressure response of neonates to tracheal intubation

Blood pressure and pulse rate responses to tracheal intubation were studied by oscillotonometric technique in 45 term neonates and 15 infants of similar postconceptual age. No hypertensive response was found in neonates intubated awake and pressures did not differ from those of babies intubated under halothane or after thiopentone and muscle relaxant. The infants did however show a significant increase in systolic and diastolic pressures which indicates that this response may develop after the first month of life.     

The effect of diltiazem on the cardiovascular response to tracheal intubation

The efficacy of diltiazem in the attenuation of the cardiovascular response to laryngoscopy and tracheal intubation was studied in patients who received 0.2 or 0.3 mg/kg diltiazem 60 seconds before the start of laryngoscopy. These data were compared with a control group who received saline. Each group consisted of 10 patients who had elective surgery. Patients who received saline showed a significant increase in mean arterial pressure and rate pressure product associated with tracheal intubation. These increases after tracheal intubation were reduced in diltiazem-treated patients compared with those of the control group (p less than 0.05). The data suggest that a bolus injection of diltiazem is a simple, practical and effective method to attenuate the hypertensive response to laryngoscopy and tracheal intubation.     

Nicardipine versus lidocaine for attenuating the cardiovascular response to endotracheal intubation

Purpose. The aim of this study was to compare the efficacy of nicardipine and lidocaine in attenuation of cardiovascular responses to endotracheal intubation. Methods. In a randomized, double-blind, controlled trial, 60 unpremedicated (ASA I) patients undergoing elective sur-gery were given either 30 μg·kg⁻¹ nicardipine or 1.5 mg·kg⁻¹ lidocaine intravenously 2 min before intubation. Laryngoscopy and tracheal intubation were performed 1 min after induction of anesthesia with 5 mg·kg⁻¹ thiopentone, followed by administration of 1.5 mg·kg⁻¹ succinylcholine intravenously. Blood pressure and heart rate were monitored at baseline and every minute until 4 min after intubation. Repeated-measures ANOVA, Student's t test, the chi-square test, and 95% confidence intervals were used as appropriate. P < 0.05 was considered statistically significant. Results. Baseline hemodynamic variables were not different between the groups. After administration of either agents, diastolic blood pressure and mean blood pressure were significantly lower in the nicardipine group. The heart rate in the nicardipine group was significantly higher. The mean between-group differences in diastolic blood pressure, mean blood pressure, heart rate, and rate-pressure product at baseline and 1 min after starting laryngoscopy were statistically significant. Conclusion. Nicardipine can be used as an alternative to lidocaine in attenuation of cardiovasculars response to tracheal intubation in patients without ischemic heart disease. Received for publication on August 3, 1999; accepted on December 25, 1999     

Cricoid pressure and the pressor response to tracheal intubation

Forty healthy adults who underwent rapid sequence induction of anaesthesia were allocated randomly to receive either cricoid pressure or its stimulation. The anticipated increase in systolic arterial pressure and heart rate after laryngoscopy and tracheal intubation were not altered significantly by the application of cricoid pressure.     

不同剂量瑞芬太尼复合靶控输注异丙酚对心脏瓣膜置换术病人气管插管时血液动力学反应的影响

目的 评价不同剂量瑞芬太尼复合靶控输注(TCI)异丙酚对心脏瓣膜置换术病人气管插管时血液动力学反应的影响.方法 拟行心脏瓣膜置换术的风湿性心脏病病人30例,随机分为3组(n=10):芬太尼组(Ⅰ组)、小剂量瑞芬太尼组(Ⅱ组)和大剂量瑞芬太尼组(Ⅲ组).麻醉诱导:Ⅰ组静脉注射芬太尼10 μg/kg,然后持续静脉输注芬太尼10 μg·kg-1·h-1;Ⅱ组和Ⅲ组静脉注射瑞芬太尼1μg/kg,然后分别持续静脉输注瑞芬太尼0.5、1.0 μg·kg-1·min-1.3组静脉注射芬太尼或瑞芬太尼后3min开始TCI异丙酚,初始血浆靶浓度为1.0 μg/ml,逐渐递增至2.0 μg/ml.静脉注射罗库溴铵0.6 mg/kg后气管插管.分别在麻醉诱导前(T0)、诱导期间血压最低值时(T1)、插管前即刻(T2)、插管后1 min(T3)、插管后2 min(T4)及插管后5 min(T5)时记录心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、肺毛细血管楔压(PCWP)、心脏指数(CI)、外周血管阻力指数(SVRI)及左室每搏功指数(LVSWI),并于上述时点测定混合静脉血氧饱和度(S(v)O2).记录诱导期间低血压及气管插管心血管反应的发生情况.结果 3组间麻醉诱导期间低血压及气管插管心血管反应的发生率差异无统计学意义(P＞0.05).与T0比较,各组T1,2时HR和MAP均降低,Ⅱ组T3时HR和MAP升高,Ⅲ组T4时MAP降低,Ⅰ组和Ⅱ组T2-4时S(v)O2升高(P＜0.05);3组间各时点CVP、PCWP、CI、LVSWI和S(v)O2差异无统计学意义(P＞0.05).结论 复合TCI异丙酚(血浆靶浓度2.0 μg/ml)时,静脉注射瑞芬太尼1 μg/kg负荷剂量后,持续静脉输注0.5 μg·kg-1·min-1麻醉诱导时血压和HR下降适度,可较好地抑制心脏瓣膜置换术病人气管插管时血液动力学反应.