不同静脉麻醉药对诱导和气管插管期间血压、ET和NO的影响

EFFECT OF THREE INTRAVENOUS ANESTHETICS ON Bp,ET AND NO RESPONSE TO INDUCTION OF GENERAL ANESTHESIA AND TRACHEAL INTUBATION

目的探讨硫喷妥钠、异丙酚、依托咪酯诱导对气管插管期间血压、脉搏及其内皮素(endothelin,ET)、一氧化氮(nitric oxide,NO)的影响。方法择期气管插管全麻患者40例,随机分为3组:硫喷妥钠组(T组)、异丙酚组(P组)、依托咪酯组(E组)。常规全麻诱导气管插管,分别在诱导前、诱导后插管前、插管后1、35、min记录血压、心率,并同时收集血样,分别采用放射免疫技术和硝酸还原酶法测定血中ET、NO的浓度。结果全麻诱导后P组血压下降幅度最大,P组ET显著降低,T组和P组的NO显著升高。气管插管后1 min各组血压、脉搏均显著升高,各组ET、ET/NO均升高,NO均降低。结论3种药物临床剂量对血压的抑制程度分别为异丙酚>硫喷妥钠>依托咪酯,并与对应时间点体内ET、NO的变化有相关关系。

Objective To investigate the changes of blood pressure（Bp）, heart rate（HR） and endothelin （ET）, nitric oxide （NO） during induction of general anesthesia by tracheal intubation with thiopental, propofol and etomidate. Methods Forty patients, scheduled for surgery requiring tracheal intubation general anesthesia, were randomly divided into three groups： group T（n =13）, group P（n =14） and group E（n =13）. Tracheal intubation was performed under induction of general anesthesia, systolic blood pressure, diastolic blood pressure, mean arterial pressure（MAP）, HR and blood samples were taken at To （before induction）, T1 （after induction before intubation）, T2 （1 min after intubation）, Ta （3 min） and T4 （5 min）. Plasma ET and NO concentrations were detected by radioimmunoassy （gamma counter） and nitrate reductase （722 spectrophotometer） respectively. Results After induction of general anesthesia, MAP in group P was decreased most significantly,ET in group P was also decreased significantly, while NO in group T and group P was significantly increased. One minute after tracheal intubation, Bp and HR were significantly increased and ET, ET/NO increased, while NO decreased in all the groups. Conclusion For their effects on decreasing Bp during induction of general anesthesia, propofol was strongest, followed by thiopental and etomidate. Effect of induction of general anesthesia and tracheal intubation on Bp may be related to ET and NO.