静脉注射硝苯地平预防气管插管副反应的临床研究

Effects of nifedipine on stress responses to tracheal intubation: a randomized placebo-controlled clinical study

30例患者随机分为三组:Ⅰ组(对照组),Ⅱ组和Ⅲ组分别于诱导前5分钟静滴芬太尼(5μg/kg)和硝苯地平(40μg/kg)。气管插管前右按规定时点测定血压、心率并计算RPP,同时测定血浆内皮素(ET)、心钠素(ANP)、血栓素A_2(TXB_2)和前列环素(6-keto-PGF_1α)含量。结果显示Ⅲ组插管后各时点血压均未超过用药前值,但心率增快。插管后Ⅰ组ANP和TXB_2升高,明湿高于Ⅱ、Ⅲ组(P<0.01),Ⅱ、Ⅲ组6-keto-PGF_1α分别升高51.1%和32.4%(P<0.01),三组ET均无明显变化。结果表明硝苯地平可以有效地预防气管内插管的心血管反应,与芬太尼相比各有优缺点。

The aim of this study was to investigate the effects of nifedipine on stress responses to tracheal intubation. Thirty adult patients, ASA Ⅰ to Ⅱ, scheduled for elective surgery, were randomly assigned to receiving intravenous infusion of normal saline 30ml (group Ⅰ). fentanyl 5μg/kg (group Ⅱ) or nifedipine 40 μg/kg(group Ⅲ), respectively. After intravenous thiopental, valium and atracurium. the tracheal intubation was performed. SP, DP, HR and RPP were determined before administration, immediately before and after intubation. 1, 3 and 5 min following intubation separately, and the venous blood samples were taken at correspondingly later 5 times to measure plasma concentrations of endotheline(EF), atrial natriuretic polypeptide (ANP), TXB_2 and 6-keto-PGF_1 α by radioimmunoassay individually. Following intubation. MAP went up in group Ⅰ and transiently in group Ⅱ and Ⅲ, HR in creased by 36.6% and 33.3% in group Ⅰ and Ⅲ and remained stable in group Ⅱ, RPP rose in group Ⅰ and rept statistically unchanged in group Ⅱ and Ⅲ, ET level stayed constant in all three groups, levels of ANP and TXB_2 ascended in group Ⅰ, transiently in group Ⅱ and did not vary in group Ⅲ, 6-keto-PGF_1α level were raised in group Ⅱ, transiently in group Ⅲ and did not change in group Ⅰ, and TXB_2/6-keto-PGF_1α ratio(T/K) shoot up in group Ⅰ and reduced in group Ⅱ and Ⅲ. As compared with those in group Ⅰ, before intubation, ANP level increased in group Ⅱ and Ⅲ. 6-keto-PGF_1α level decreased and T/K rose in group Ⅲ; after intubation, levels of ANP and 6-keto-PGF_1 α went up in group F, transiently in group Ⅲ, and TXB_2 and T/K values went down in group Ⅱ and Ⅲ. It is suggested that prophylactic intravenous nifedipine may effectively depress the cardiovascular and hormone responses to tracheal intubation, but can not take complete place of fentanyl for this procedure.