瑞芬太尼复合艾司洛尔对全麻患者气管插管时心血管指标的影响

目的 评价瑞芬太尼复合艾司洛尔对全麻患者气管插管时心血管系统的影响.方法 选择择期上腹部手术患者60 例,ASAⅠ - Ⅱ级,随机分为3 组（n = 20）：瑞芬太尼2 μg/kg组（Ⅰ组）,芬太尼4 μg/kg ＋ 艾司洛尔1 mg/kg 组（Ⅱ组）和瑞芬太尼2 μg/kg ＋ 艾司洛尔1 mg/kg组（Ⅲ组）.分别注入上述药物、丙泊酚2 mg/kg 和阿曲库铵1.5 mg/kg 后行气管插管,机械通气.记录麻醉诱导前（T1）、麻醉诱导后1 min（T2）、气管插管后即刻（T3）、气管插管后1 min（T4）、3 min（T5）及10 min（T6）的HR、收缩压（SP）、舒张压（DP）,并于T1、T2、T4 时分别采集桡动脉血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 的浓度降低（P 〈 0.05）;Ⅰ组T3 时HR、SP、DP 升高,Ⅱ组和Ⅲ组差异无统计学意义.结论 瑞芬太尼复合艾司洛尔可更好地预防全麻患者气管插管时的心血管副作用.

Effect of remifentanyl combined with esmolol on cardiovascular response during endotrachealintubation under general anesthesia

Objective To evaluate effect of remifentanyl combined with esmolol on cardiovascular response during endotracheal intubation under general anesthesia. Method sixty patients （ASA I - II ） who undergoing elective surgery were randomly divided into 3 groups （n = 20）： remifentanyl 2μg/kg （Group I ）, fentanyl 4 μg/kg combined with esmolol 1 mg/kg （Group 11 ） and remifentanyl 2 μg/kg combined with esmolol 1 mg/kg （Group III ）. After intravenous admistration of the above drugs and propofol 2 mg/kg and atracurium 1.5 mg/kg, endotracheal tube was intubated and mechanical verntilation was performed. Heart rate （HR）, systolic pressure （SP） and diastolic pressure （DP） were recorded before induction （T1）, 1 rain after induction （T2）, at the onset of endotracheal intubation （T3）, 1 rain after intubation（T4）, 3 min after intubation （T5） and 10 rain after intubation （T6）. And arterial blood sample was taken at T1, T2 and T3 for detecting the levels of serum adrenaline and noradrenaline. Result HR, SP, DP and serum levels of adrenaline and noradrenaline were significantly lower than those in Group I （P 〈 0.05）. HR, SP and DP in Group HI were lower than Group II. HR, SP and DP at T3 were significantly higher than those at other time points in Group I （P 〈 0.05）, but there were no significant difference in those variables between Group II and Group llI. Conclusion Remifentanyl combined with esmolol can prevent cardiovascular response during endotracheal intubation of patient under general anesthesia.