兰地洛尔对丙泊酚麻醉作用的影响及对气管插管心血管反应的抑制效应

Effects of landiolol on anesthetic action of propofol and hemodynamic response induced by tracheal intubation

目的探讨兰地洛尔对丙泊酚麻醉作用的影响及对气管插管心血管反应的抑制效应。方法28例ASAⅠ~Ⅱ级择期手术患者随机均分为两组:兰地洛尔组(L组)和对照组(C组)。L组静注兰地洛尔0·15ml/kg后,以0·04mg·kg-1·min-1维持;C组给予等容量生理盐水。用压力袖带隔离一侧前臂后,静注维库溴铵0·1mg/kg。当丙泊酚靶控输注(TCI)达到设定血浆靶控浓度后行气管内插管。记录隔离侧手臂运动情况;记录患者于诱导前、处理前(兰地洛尔或生理盐水)、进喉镜前2、1min、进喉镜即刻及插管后1、2、4min患者SBP、DBP、HR、脑电双频指数(BIS)及听觉诱发电位指数(AAI)。于诱导前、进喉镜前和插管后1min分别采动脉血6ml测定肾上腺素、去甲肾上腺素及丙泊酚的血浆浓度。结果两组各时点BIS、AAI值差异均无显著性(P>0·05);L组8例、C组9例患者插管后出现体动反应。两组插管前后肾上腺素、去甲肾上腺素及丙泊酚血浆浓度的差异均无显著性(P>0·05)。处理后L组在各时点HR均明显低于C组(P<0·01);而SBP、DBP仅在插管后1min低于C组(P<0·05),其余各时点差异无显著性。结论兰地洛尔可明显减低气管插管引起的心血管反应,但它不产生有临床意义的抗伤害刺激作用,对丙泊酚麻醉深度无明显影响。

Objective To investigate whether landiolol, a short-acting β_1-blocker, affects anesthetic action of propofol and hemodynamic response induced by tracheal intubation. Methods Twenty-eight ASA Ⅰ-Ⅱ female patients were equally allocated to receive either landiolol (group L) 0.15 ml/kg followed by 0.04 mg·kg^-1·min^-1or equal volume saline (group C). Landiolol or saline was started 6 min after a target-controlled infusion (TCI) of propofol (target effect-site concentration 3.5 μg/ml). After loss of consciousness, isolated-forearm technique was applied to isolate an arm before vecuronium 0.1 mg/kg iv. When TCI reached the target set, tracheal intubation was performed, and gross movement of the arm within the 1st minute after intubation was noted.Bispectral index (BIS), auditory evoked potential index (AAI) and hemodynamic parameters including SBP,DBP and HR were measured invasively pre-induction,pre-treatment (landiolol or saline), at 2 min and 1 min before laryngoscopy, just before laryngoscopy and at 1, 2, 4 min after orotracheal intubation.Radial arterial blood (6 ml) was drawn before induction, just before laryngoscopy and at 1 min after intubation ~respectively for detecting plasma concentrations of epinephrine, norepinephrine and propofol. Results^Neither BIS nor AAI showed significant difference between the two groups at each observing time point (P>0.05). Eight of 14 patients in group L and nine of 14 patients in group C moved in response to laryngoscopy and orotracheal intubation. Plasma epinephrine, norepinephrine and propofol were similar between the two groups at each observing point both before and after intubation (P>0.05). HR remained lower in group L than that in group C at each observing point after treatment^(P<0.01), but SBP and DBP were comparable at all time points except 1 min after intubation. ~Conclusion Landiolol attenuates haemodynamic, especially HR, reaction to laryngoscopy and intubation. However, it can not prevent movement in response to laryngoscopy and intubation. It also had no significant effect on BIS, AAI and plasma concentrations of epinephrine, norepinephrine or propofol. The present study suggests that landiolol produces no clinically important effect on somatic and ~arousal reactions induced by laryngoscopy and tracheal intubation in patients anesthetized with propofol.