不同剂量艾司洛尔对老年患者全麻气管拔管时心血管反应的作用

Effects of different doses of esmolol on cardiovascular responses of old patients to tracheal extubation

目的观察不同剂量艾司洛尔对老年患者气管拔管时心血管反应的作用。方法将80例择期手术病人随机分为A(对照组),B(艾司洛尔0.5mg/kg组),C(艾司洛尔1.0mg/kg组),D(艾司洛尔1.5mg/kg组)。4组拔管前分别静注生理盐水20mL、艾司洛尔0.5、1.0和1.5mg/kg(将艾司洛尔稀释至20mL),记录病人给药前、拔管时、拔管后1、3、5min时收缩压(SBP)、舒张压(DBP)、心率(HR),并计算心率和收缩压乘积(RPP)。结果A组拔管时及拔管后1minSBP、DBP、HR和RPP显著高于给药前(P<0.01);B组拔管时SBP、DBP、HR和RPP显著高于给药前(P<0.01),拔管后1minSBP、DBP、HR和RPP显著低于A组(P<0.05);C、D两组拔管时SBP、DBP、HR和RPP显著低于A、B两组(P<0.05),拔管后1minSBP、DBP、HR和RPP显著低于A组(P<0.01);C、D组拔管后5minSBP、RPP显著低于给药前(P<0.05),但D组有2例用药后发生严重心动过缓。结论静注艾司洛尔1.0mg/kg对老年患者气管拔管时的心血管反应作用效果较好且安全性更大。

[Objective] To observe the effects of different doses of esmolol on cardiovascular responses of old patients at the tracheal extubation. [Methods] The 80 patients were randomly divided into 4 groups undergoing elective surgery. Before the tracheal extubation, patients received 20 mL saline (group A), esmolol 0.5 mg/kg (group B), 1.0 mg/kg (group C), 1.5 mg/kg (group D) respectively and then the trachea was extubated 2 min later. systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) Were recorded at premedication, tracheal extubation, and 1.3.5 min after the tracheal extubation. Rate-pressure product was derived from SBP×HR. [Rsults] The SBP, DBP, HR, RPP of the patients in Group A increased significantly at the tracheal extubation and 1 min after the tracheal extubation when compared with those at premedication, (P <0.01), The SBP, DBP, HR, RPP of patients in group B were signifcantly higher at the tracheal extubation than those at premedication(P <0.01), and decreased significantly at the tracheal extubation and 1 min after the tracheal extubation compared with those in group A (P <0.01), The SBP, DBP, HR, RPP of patients in group C, Ddecreased significantly at the tracheal extubation compared witb those in group A and B (P <0.05), and the SBP, DBP, HR, RPP of patients in group C.D decreased significantly at 1 min after tracheal extubation compared witb those of patients in group A (P <0.01). The SBP, HR, RPP in group C.D decreased significantly at 3 min after the tracheal extubation compared with those in group A (P <0.05), Compared with premedication, The SBP, RPP in group C, D decreased significantly at 3~5 min after the tracheal extubation (P <0.05), but two patients in group D had a bradycardia after receiving esmolol. [Conclusion] Esmolol of 1.0 mg/kg and 1.5 mg/kg may effectively control cardiovascular responses of old patients to the tracheal extubation, but 1.0 mg/kg is safest.