选择性β1-肾上腺素能受体阻滞剂艾司洛尔对光导纤维支气管镜引导经鼻气管插管血流动力学的影响

目的：通过艾司洛尔对光导纤维支气管镜(FOB)引导经鼻气管插管血流动力学的影响，探讨有效抑制FOB引导经鼻气管插管时心血管反应的方法。方法：拟在经鼻气管插管全身麻醉下实施口腔和耳鼻喉科手术患者35例， ASAⅠ～Ⅱ级，随机分为FOB引导经鼻气管插管艾司洛尔组（艾司洛尔组）和单纯FOB引导经鼻气管插管组（对照组），艾司洛尔组前者在气管插管前2 min静脉注射艾司洛尔1 mg•kg^-1，测定麻醉诱导前后、插入气管导管时以及气管插管后1、2、3、4和5 min的SBP、DBP、MBP、HR和SpO₂的变化。结果:艾司洛尔组在插入气管插管时的心率(HR)明显低于对照组（Ｐ＜0.05）， 在插入气管导管后1 min 收缩压(SBP)、舒张压(DBP)和平均动脉压(MBP)明显低于对照组（Ｐ＜0.05），SBP、DBP、MBP和HR的最大值亦明显低于对照组（Ｐ＜0.05）；两组患者插管前后的SpO₂均保持在96%以上。 结论：临床常用麻醉深度不能完全抑制FOB引导经鼻气管插管操作导致的血压升高和心率增快反应；在气管插管前2 min静脉注射艾司洛尔1 mg•kg^-1可有效抑制FOB引导经鼻气管插管的心血管反应。

Hemodynamic responses of esmolol to nasotracheal intubation with fiberbronchoscope

Objective To evaluate the hemodynamic responses of esmolol to nasotracheal intubation with fiberbronchoscope(FOB). Methods Thirty-five ASAⅠorⅡpatients undergone stomatology and otorhinolaryngology surgery were randomly divided into fiberoptic nasotracheal intubation esmolol group (esmolol group) and fiberoptic nasotracheal intubation group (control group). The intravenous administration of esmolol 1mg·kg-1 was performed 2 min before tracheal intubation in esmolol group. Noninvasive SBP,DBP,MBP,HR and SpO2 were recorded before and after anesthetic induction,at intubation and 1,2,3,4,5 min after intubation. Results The SBP,DBP and MBP 1 min after intubation in esmolol group were significantly lower than those in control group(P<0.05). The HR at intubation in esmolol group was significantly lower than that in control group(P<0.05). The maximums of SBP,DBP,MBP and HR in esmolol group were also lower than those in control group(P<0.05). The SpO2 levels in two groups were above 96% during the test. Conclusion General anesthesia of clinical standard depth cannot inhibit effectively the increase of blood pressure and heart rate caused by nasotracheal intubation through FOB;Introvenous administration of esmolol 1 mg·kg-1 2 min before tracheal intubation can effectively inhibit cardiovascular responses caused by nasotracheal intubation through FOB.