不同麻醉诱导下小儿气管插管时的心血管应激反应

目的用随机对照前瞻性研究方法，比较小儿气管插管时心血管反应，评价不同麻醉诱导方式对插管时应激反应的抑制作用。方法58例1～6岁的患儿被随机分成P、PF及PF1组，P组静脉注射硫喷妥钠5mg／kg；PF组先静脉注射芬太尼3μg／kg，再静脉注射硫喷妥钠5mg／kg；PF1组先静脉注射芬太尼3μg／kg，再静脉注射硫喷妥钠5mg／kg，同时吸入3％异氟醚。所有患儿由同一位医生进行气管插管，记录其麻醉前以及插管前、后的心率和血压。结果插管后P组的心率和血压最高，不仅显著高于插管前，还显著高于基础值（P〈0．05）。PF组插管后的心率和血压虽然也高于插管前，但低于P组，而且与基础值比较差异无统计学意义。PF1组插管后的血压仅略高于插管前，但比基础值低（P〈0．05），在3组中最低（P〈0．05），且升幅最小（P〈0．05），其收缩压和舒张压的升幅分别为10％和24％。结论给患儿插管时联合应用硫喷妥钠、芬太尼和异氟醚，心血管反应最小，提示可以较好地抑制插管所至的应激反应。

The cardiovascular stress reaction to tracheal intubation under different anesthesia induction in pediatric patients

Objective Random-controlled perspective study was performed to compare cardiovascular stress reaction to tracheal intubation in pediatric patients and evaluate the inhibitory effect of different anesthesia induction on the cardiovascular stress reaction during tracheal intubation. Methods According to the anesthesia type, 58 children of 1 to 6 years old were randomly divided into 3 groups, group P （5mg/kg of thiopental injected intravenously by a bolus）, group PF （given 3 μg/kg of fentanyl injection intravenously, followed by 5 mg/kg of thiopental intravenous injection） and group PFI （given 3μg/kg of fentanyl injection intravenously, followed by 5 mg/kg of thiopental intravenous injection and 3% isoflurane inhalation）. All tracheal intubation was operated by the same clinician. Blood pressure （BP） and heart rate （HR） before anesthesia, before and after intubation were recorded. Results HR and BP after intubation were the highest in group P, significantly higher than that before intubation and basic value （P〈0.05）. HR and BP after intubation in group PF were higher than that before intubation, but lower than that in group P, not different from basic value. HR and BP after intubation in group PFI were the lowest in 3 groups with a lowest ascending amplitude （that of systolic blood pressure and diastolic blood pressure was 10% and 24% respectively）, a little higher than that before intubation, but significantly lower than basic value. Conclusion It suggests that thiopental, fentanyl and isoflurane should be administrated simultaneously to reduce cardiovascular reaction and inhibit the stress reaction caused by tracheal intubation.