应用艾司洛尔和二硝酸异山梨酯对气管内插管拔管时的心血管反应的影响

Effects of esmolol and isosorbide dinitrate on cardiovascular responses during tracheal extubation

目的观察艾司洛尔和硝酸异山梨酯对全身麻醉患者苏醒后气管内导管撤除期间心血管反应的防治效果。方法ASAⅠ～Ⅱ级,全身麻醉下手术患者80人,随机分为4组,分别于气管导管撤除前给予生理盐水5ml(Ⅰ组,n=20),硝酸异山梨酯20μg/kg(Ⅱ组,n=20),艾司洛尔1mg/kg(Ⅲ组,n=20)以及艾司洛尔1mg/kg+硝酸异山梨酯20μg/kg(Ⅳ组,n=20)。记录患者麻醉前和围拔管期心率(HR)、平均动脉压(MAP)和收缩压鄄心率乘积(RPP),随访患者相关并发症。结果与Ⅰ组相比较,围拔管期Ⅱ、Ⅲ组患者HR、MAP和RPP均明显降低(P<0.05),Ⅳ组患者MAP低于Ⅲ组,更趋于平稳(P<0.05)。所有患者均未出现低血压和心肌缺血等并发症。结论全身麻醉气管内导管撤除前适量使用艾司洛尔可以在一定程度上缓解患者心血管反应,合并使用硝酸异山梨酯效果更佳。

Objective To observe the effects of esmolol and isosorbide dinitrate on cardiovascular responses to tracheal extubation. Methods 80 patients undergoing general anesthesia （ASA Ⅰ - Ⅱ ） were randomly divided into 4 groups. Before the tracheal extubation, patients received 8ml saline （group Ⅰ ）, isosorbide dinitrate 20p, g/kg （group Ⅱ ）, esmolol 1.0mg/kg （group Ⅲ ）, esmolol 1.0mg/kg＋isosorbide dinitrate 20p, g/kg（group Ⅳ ） respectively. Heart rate （HR）, mean arterial pressure （MAP） and rate-pressure product （RPP） were recorded before and after tracheal extubation. The correlative cardiovascular complications of patients were recorded too.Results Comparing with group Ⅰ, the HR , MAP and RPP of patients in Group Ⅱ , m and Ⅳ were decreased significantly during the peritracheal extubation （P 〈 0.05）, as well as MAP of patients in Group IV was lower than that group Ⅲ （P 〈 005） No correlative cardiovascular complications of patients were found. Conclusion Esmolol can reduce cardiovascular response to the tracheal extubation, and the esmolol combined with isosorbide dinitrate are more effective to control the responses.