艾司洛尔对依托咪酯诱导气管插管时脑氧供需平衡和能量代谢的影响

目的:观察艾司洛尔对依托咪酯诱导气管内插管时脑氧供需平衡和能量代谢的影响。方法:将24例择期腹部手术患者随机分为艾司洛尔(A)组和对照(B)组,每组各12例。A组全麻诱导应用依托咪酯、咪达唑仑、芬太尼和维库溴铵,并在插管前30s静注艾司洛尔1mg/kg;B组除不用艾司洛尔外,其他与A组相同。分别于全麻诱导前、气管插管后即刻采集颈内静脉和桡动脉血,检测血糖、血乳酸盐及血气,记录MAP和HR;并计算脑动-静脉血氧含量差(Da-jvO2),脑氧摄取率(CERO2),葡萄糖摄取率(GluER),脑动-静脉血乳酸盐浓度差(Da-jvLac)。结果:与诱导前比较,A组插管后即刻MAP、HR无显著变化(P0.05),SjvO2增高、Da-jvO2和CERO2降低(P均0.05);B组插管后即刻MAP、HR及SjvO2明显增高(P0.01),Da-jvO2和CERO2显著降低(P0.01)。B组插管后即刻MAP、HR及SjvO2水平明显高于A组(P0.01),而Da-jvO2和CERO2水平明显低于A组(P0.05)。两组GluER和Da-jvLac无显著变化(P0.05)。结论:麻醉诱导时给予艾司洛尔1mg/kg可减轻依托咪酯诱导气管内插管对脑氧供需平衡的影响,但不影响脑的能量代谢。

Effect of Esmolol on Cerebral Oxygen Metabolism and Energy Metabolism During Tracheal Intubation Induced by Etomitade

Objective To investigate the effect of esmolol on cerebral oxygen metabolism and energy metabolism during tracheal intubation induced by etomitade. Methods Twenty-four ASA I-II score patients undergoing selective abdominal operations were randomized into two groups with 12 cases each： esmolol group （A） and control group （B）. Each group was administered with midazolam, etomidate, fentanyl and vecuronium during the induction of general anesthesia. Esmolol was only administered with 1 mg/kg before anesthesia in group A. Mean arterial pressure （MAP） and heart rate （HR） were recorded, and blood samples were taken from radial artery and internal jugular vein for determination of blood gas analysis, glucose and lactic acid levels before the induction and after tracheal intubation. The cerebral arterio-venous differences in oxygen content （Da-jvO2）, cerebral oxygen extraction rate （CERO2）, glucose extraction rate （GluER）, the cerebral arterio-venous differences in lactic acid content （Da-jvLac） were calculated according to the Fick Formula. Results In group A, compared with data before induction, MAP and HR had no significant differences （P〉0.05） but Da-jvO2 and CERO2 obviously decreased, at the same time, SjvO2 raised after tracheal intubation （P〈0.05）. In group B, the data after tracheal intubation concluded MAP, HR and SjvO2 raised, and Da-jvO2 and CERO2 obviously decreased （P〈0.01）. In group B compared with group A, the data after tracheal intubation concluded MAP, HR and SjvO2 raised, Da-jvO2 and CERO2 obviously decreased （P〈0.05 or P〈0.01）, but GluER and Da-jvLac had no significant differences （P〉0.05）. Conclusion Esmolol can reduce the import of cerebral oxygen metabolism during tracheal intubation induced by etomitade, but esmolol has no effect on cerebral energy metabolism.