艾司洛尔和乌拉地尔联合用药预防气管插管心血管反应的观察

Effects of Combinative Administration of Esmolol and Urapidil on Cardiovascular Response During Tracheal Intubation

目的观察艾司洛尔和乌拉地尔联合用药预防气管插管心血管反应的临床效果。方法ASAⅠ-Ⅱ级拟在经口气管插管全麻下手术病人48例,随机分为四组(A、B、C、D组,n=12)。于麻醉诱导2min前静注:A组,艾司洛尔2mg/Kg;B组,乌拉地尔0.5mg/Kg;C组,艾司洛尔1mg/Kg+乌拉地尔0.25mg/Kg;D组,生理盐水1mL。用芬太尼和丙泊酚麻醉诱导,直接喉镜下气管插管。吸入异氟醚维持麻醉。监测SBP、DBP、HR和ECG。于术前、用药后2min、插管后1、3、5、7min记录上述指标,计算心率-收缩压乘积(RPP)。结果插管后1min四组SBP、DBP、HR和RPP值均明显升高(p<0.05),D组比较,A组、B组、C组SBP、DBP、HR和RPP值低于D组(p<与0.05),与C组比较,A组SBP和DBP高于C组(p<0.05)B组HR高于C组(p<0.05)A组和B组RPP值高于C组,,(p<0.05)管后3min、5min、7min四组SBP、DBP、HR和RPP值逐步下降至术前水平,其中A组HR下降最快,B;插组SBP和DBP下降最快,C组RPP值下降最快。结论联合应用艾司洛尔和乌拉地尔更能有效控制气管插管的心血管反应,特别是RPP值的升高,于心肌缺血病人或许有益。

Objective To observe the clinical effects of the combinative administration of esmolol and urapidil on cardiovascular response during tracheal intubation. Methods 48 patients with ASA status Ⅰ- Ⅱ seheduled for selected surgery under general anesthesia with oral intubation were divided into 4 groups （n=12） and esmolol 2mgKg in group A, urapidil 0.5mg/Kg in group B , esmolol 1 mg/Kg with urapidil 0.25mg/Kg in group C ,or normal saline 1 mL in group D was injected intravenously before the induction of anesthesia . Anesthesia was induced with fentanyl and propofol followed by oral tracheal intubation under direct laryngoscope, and maintained with isoflurane .The SBP, DBP, HR were monitorial and recorded before the surgery, at 2 rain after the drug administration, and at 1 min, 3min, 5min, 7min after the intubetion. The RPP was caculated with the formula （RPP=SBPxHR）. Results At 1 min after the intubation, the SBP, DBP, HR and RPP in the all 4 groups increased compared with those before the surgery （p〈0.05）, the SBP, DBP and RPP in group A, group B, group C were lower than those in group D （p〈0.05）; When compared with the group C, the SBP, DBP in group A were higher than those in group C （p〈0.05） , the HR in group B was higher than that in group C （p〈0.05） and the RPP in group A or group B was higher than that in group C （p〈0.05）; At the 3min, 5min, 7min after the intubetion ,the SBP, DBP, HR and RPP in the 4 groups decreased gradually to the preoperative level, and the HR in group A, the SBP and DBP in group B and the RPP in group C reduced fastest. Conclusions The combinative administration of esmolol and urapidil can more effectively attenuate the cardiovascular response during the tracheal intubetion, especial for the RPP value,which with the patent benefit for the patient suffered from myocardial isehemia.