Upsher喉镜与直接喉镜经口气管插管对血流动力学的影响

目的比较Upsher喉镜和Macintosh直接喉镜经口气管插管对血流动力学的影响。方法将50例ASAⅠ～Ⅱ级、实施择期整形外科手术的患者随机分为Upsher喉镜(U)组(n=25)和Macintosh直接喉镜(M)组(n=25),常规静脉麻醉诱导后分别采用Upsher喉镜或Macintosh直接喉镜实施经口气管插管操作,监测麻醉诱导前后、气管插管时和气管插管后5min内的收缩压(SBP)、舒张压(DBP)、心率(HR)和心率-收缩压乘积(RPP)的变化,并记录气管插管时间。结果两组患者的气管插管时间差异无显著性(P>0.05)。麻醉诱导后两组患者的血压和RPP比麻醉诱导前显著降低(P<0.05);气管插管时的血压和RPP比麻醉诱导后显著升高(P<0.05),持续1～2min后逐渐降低至麻醉诱导后水平。观察期两组患者的血压升高幅度均未超过麻醉诱导前水平(P>0.05),但HR的最大值显著升高(P<0.05)。M组RPP的最大值比麻醉诱导前显著升高(P<0.05),而U组差异无显著性(P>0.05)。观察期各对应时间点的血压、HR和RPP在两组间差异无显著性(P>0.05)。结论Upsher喉镜和Macintosh直接喉镜经口气管插管可产生相似的心血管反应。临床常用的全身麻醉诱导用药剂量能有效抑制两种喉镜经口气管插管引起的加压反应,但不能抑制其引起的心率增快反应。与Macintosh直接喉镜相比,Upsher喉镜在预防经口气管插管的心血管系统应激反应方面无明显优越性。

Hemodynamic responses to orotracheal intubation with upsherscope or Macintosh direct laryngoscope

OBJECTIVE: To compare the hemodynamic responses to orotracheal intubation via Upsher-scope (USSP) or Macintosh direct laryngoscope (MDLS) under general anesthesia. METHODS: Fifty patients with ASA grade I-II and undergoing the elective plastic surgery and requiring orotracheal intubation were randomly allocated to either the USSP (U group) (n=25) or MDLS (M group) (n=25). After standard intravenous anesthetic induction, orotracheal intubation was performed using a USSP or a MDLS. Noninvasive systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded before and after anesthetic induction, at intubation and every minute thereafter for 5 minutes. The time spent in tracheal intubation was recorded. The mean blood pressure (MBP) and rate-pressure product (RPP) were calculated. RESULTS: The intubation time was not significantly different between these two groups (P > 0.05). After anesthetic induction, SBP, DBP, MAP, and RPP in these two groups decreased significantly as compared with preinduction values. The orotracheal intubation caused significant increases in SBP, DBP, MAP, and RPP in these two groups in comparision with postinduction values (P < 0.05), but these hemodynamic changes lasted only 1 to 2 minutes and then decreased gradually to the postinduction level. The blood pressure changes caused by orotracheal intubation did not exceed the preinduction values (P > 0.05). As compared to, the maximal HR values in these two groups during observation (from the beginning of intravenous anesthetic induction to 5 min after intubation) were significantly higher than their preinduction values (P < 0.05). The maximal RPP values in M group during observation were significantly higher than their preinduction values (P < 0.05), but no such significant difference was observed in U group (P > 0.05). The hemodynamic data at each time point during the observation had no significant differences between these two groups. (P > 0.05). CONCLUSIONS: Orotracheal intubation using the USSP and MDLS may result in similar hemodynamic responses. The standard general anaesthesia can effectively inhibit the pressor, but not the tachycardiac responses caused by orotracheal intubation via USSP or MDLS. USSP is not superior than MDLS in palliating the adverse cardiovascular stress responses to orotracheal intubation.