艾司洛尔抑制气管插管反应机制的探讨--血浆儿茶酚胺水平与脑电双频指数的关系

Mechanism of the preventing of endotracheal intubation response with esmolol-the relationship between the plasma catecholamine level and bispectral index

目的:观察艾司洛尔对丙泊酚麻醉诱导气管插管时血浆儿茶酚胺水平与脑电双频指数(BIS)变化的关系,探讨艾司洛尔抑制气管插管反应的机制。方法:30例患者随机分为两组即对照组及用药组。对照组静脉注射生理盐水10mL负荷量后静脉滴注生理盐水;用药组将艾司洛尔1mg/kg稀释于生理盐水10mL中静脉注射后以250μg/(kg·min)微量泵输入,然后行全麻诱导气管插管。两组分别于麻醉诱导后气管插管前和插管后3min时记录患者脑电双频指数(BIS)、收缩压(SP)、舒张压(DP)和心率(HR),同时分别抽取8mL动脉血标本用于测定血浆肾上腺素(E)和去甲肾上腺素(NE)浓度。结果:插管后3min,对照组BIS(63.53±3.11)、NE(2.02±0.68)和E(0.58±0.07)分别高于插管前水平的BIS(42.6±3.46)、NE(1.63±0.38)和E(0.54±0.04),P均<0.05,用药组BIS、NE、E水平无明显改变。插管后3min,对照组NE(2.02±0.68)和E(0.58±0.07)高于用药组NE(1.84±0.43)和E(0.53±0.04)(P<0.05),对照组BIS(63.53±3.11)和△BIS(20.93±4.57)明显高于用药组的BIS(43.13±3.16)和△BIS(7.53±3.0)(P<0.01),对照组插管后SP(148±20)和HR(89±180)高于插管前水平(P<0.05);用药组插管后SP、DP和HR与插管前相比无明显改变。结论:艾司洛尔通过抑制气管插管时外周交感神经的兴奋,直接减少血浆中NE和E的释放,推论其可能间接减少中枢NE和E的浓度,而抑制气管插管后BIS的反应性增加。

Objective： To observe the relationship between the level of catecholamine in plasma with bispectral index during endotracheal intubation with propofol anesthesia in order to investigate the mechanism of the preventing of endotracheal intubation response with esmolol. Methods： Thirty patients were randomly allocated into two groups： control group （n = 15） and esmolol group （n = 15）. The patients received esmolol 1 mg/kg followed by 250 μg/（ kg · min） in esmolol group and saline in control group. Two minutes later, the patients received propofol 2 mg/kg for induction. Bispectral index （BIS）, systolic pressure （SP）, diostolic pressure （DP）, and heart rate （HR） were measured before endotracheal intubation and 3 min after intubation, at the same time 8 mL arteral blood was taken for the measurement of the concentrations of norephinephrine（NE） and ephinephrine（E） in plasma. Results： The level of BIS （63.53 ± 3.11 ）, NE （2.016 ± 0.681 ） and E （0. 578 ± 0. 072） in control group 3 min after endotracheal intubation were increased significantly than those before intubation （ P 〈 0.05 ）, but there were no significant change in the level of BIS, NE and E in esmolol group 3 min after endotracheal intubation . There were significant differences in the concentrations of NE （2. 016 ± 0. 681 ）and E （0. 578 ± 0. 072） in plasma 3 min after intubation between the two groups （P 〈 0.05） and there were also significant differences in BIS（63.53 ± 3.11 ） and △BIS （20.93 ± 4.57 ）3 min after intubation between the two groups （P 〈 0.01 ）. SP（ 148 ± 20）and HR（89 ± 180） in control group were increased after intubation than those before intubation （P 〈 0.05 ） . There were no significant differences in SP, DP and HR in esmolol group after intubation than those before intubation. Conclusion： Esmolol can reduce the plasma concentrations of NE and E through preventing periopheal sympathetic nerve response to intubation and can reduce BIS arousal reactions after endotracheal intubation.