不同麻醉诱导下小儿气管插管时的心血管应激反应

The cardiovascular responses to tracheal intubation in pediatric patients

目的用随机对照前瞻性研究方法,比较小儿气管插管时心血管反应,评价不同麻醉诱导方式对插管时应激反应的抑制作用.方法68例1～6岁的患儿被随机分成P、PF及PFI组,P组静脉注射硫喷妥钠5 mg/kg;PF组先静脉注射芬太尼3 μg/kg,再静脉注射硫喷妥钠5 mg/kg;PFI组先静脉注射芬太尼3μg/kg,再静脉注射硫喷妥钠5 mg/kg,同时吸入3%异氟醚.所有患儿由同一位医师进行气管插管,记录其麻醉前以及插管前后的心率和血压.结果插管后P组的心率和血压最高,不仅显著高于插管前,还显著高于基础值（P＜0.05）.PF组插管后的心率和血压虽然也高于插管前,但低于P组,而且与基础值比较没有显著性差异.PFI组插管后的血压仅略高于插管前,但比基础值低（P＜0.05）,在3组中最低（P＜0.05）,且升幅最小（P＜0.05）,其收缩压和舒张压的升幅分别为11%和26%.结论给患儿插管时联合应用硫喷妥钠、芬太尼和异氟醚,心血管反应最小,提示其可以较好地抑制插管所至的应激反应.

Purpose To compare cardiovascular responses to tracheal intubation in 68 children of 1 to 6 years old under 3 different type of anesthesia. Methods Patients were randomly allocated into 3 groups. Group P received iv bolus thiopental 5 mg/kg, group PF received thiopental 5 mg/kg and fentanyl 3 μg/kg, group PFI received thiopental 5 mg/kg, fentanyl 3 μg/kg while inhaling 3% isoflurane. Blood pressure （BP） and heart rate （HR） pre-anesthesia, pre- and post-intubation were measured noninvasively. Results HR and BP after intubation were highest in group P. Patients in group PF maintained their HR and BP to pre anesthesia level but the increasing percentage from pre-intubation value was similar with group P. Patients in group PFI had the lowest value of both BP and its increasing percentage （11% and 26% for systolic and diastolic pressure respectively） within the 3 groups. Conclusions Induction with thiopental and fentanyl while inhaling isoflurane can attenuate cardiovascular responses to tracheal intubation effectively in pediatric patients.