ATP阻抑正常血压病人气管插管反应的探讨

Attenuation of Cardiovascular Response to Tracheal Intubation with ATP

作者研究小剂量ＡＴＰ阻抑插管反应的有效性。３０例ＡＳＡⅠ级择期手术病人分为对照组、ＡＴＰ０．０５ｍｇ／ｋｇ组和ＡＴＰ０．１ｍｇ／ｋｇ组（每组１０例）进行比较观察。硫喷妥钠、芬太尼、琥珀胆碱诱导并肌肉完全松弛后，在２～３ｓ内注毕预定剂量ＡＴＰ或生理盐水，同时在３０ｓ内完成插管操作。于诱导前即刻、诱导后１ｍｉｎ、２ｍｉｎ（肌肉完全松弛）、２．７５ｍｉｎ（插管完成后０．２５ｍｉｎ）、３，３．５，４，５，６ｍｉｎ各时相分别记录ＥＣＧ、ＨＲ、ＳＢＰ及ＭＡＰ并计算ＲＰＰ。结果证明，尽管采用两种小剂量ＡＴＰ都有阻抑ＭＡＰ、ＨＲ、ＲＰＰ增高的效应，其中以０．１ｍｇ／ｋｇ组的阻抑效应优于０．０５ｍｇ／ｋｇ组。根据ＡＴＰ半衰期短、起效快、作用时间短的特点，强调ＡＴＰ用药与气管插管应在时机上充分吻合，否则将归无效。运用ＡＴＰ０．１ｍｇ／ｋｇ快速静注，未见血压过降和心动过缓等副作用，认为适用于心脑血管疾患病人阻抑插管应激反应。

aryngoscopy and tracheal intubaiton often cause hypertension,tachycardia and arrhythmia. The efficacy ofloW, dose of ATP in attenuating the response was compared with that of normal saline(NS).30 patients (ASAⅠ )undergoing elective surgery were randomly divided into 3 groups (10 patients each ).Anesthesia was induced withthiopentone,fentanyl and succinylcholine iv. After full muscular relaxation,a bolus of ATP 0.05mg/kg or 0.1mg/kg or NS was injectcd iv,within 2～3seconds just before laryngoscopy. Tracheal intubation was performed within30 seconds.Patients receiving NS showed a significant increase in MAP,HR and RPP associated with tracheal intu-bation.There was no remarkable increase in HR found in both ATP 0.05mg/kg and 0.1mg/kg groups,There wereno hypotension and bradycardia found in the ATP groups.Based on the charachateristic of rapid onset and short ac-tion of ATP, it is important that the administration of ATP coincide with tracheal intubation in timing. The datasuggest that a bolus injection of ATP 0.1mg/kg is a simple,practical and effective for attenuating the cardiovascu-lar response to laryngoscopy and tracheal intubation,especially in patients suffering from cardiavascular and cere-brovascular disease.