芬太尼复合艾司洛尔或利多卡因对高血压患者气管插管时心血管反应影响的比较

Comparison of Effect of Fentanyl and Esmolol or Lidocaine on Cardiovascular Response to Tracheal Intubation in Patients with Hypertension

目的比较芬太尼复合艾司洛尔或利多卡因对原发性高血压患者气管插管时心血管反应的影响。方法择期上腹部手术合并原发性高血压患者60例,年龄40-65岁,体重48-78kg,ASAI或Ⅱ级,随机分为3组（n=20）：芬太尼3μg/kg组（Ⅰ组）、芬太尼3μg/kg＋艾司洛尔1mg/kg组（Ⅱ组）和芬太尼3μg/kg＋利多卡因1mg/kg组（Ⅲ组）。3组均静脉注射咪达唑仑0.05mg/kg、丙泊酚1.5mg/kg和罗库溴铵0.8mg/kg麻醉诱导后气管插管,机械通气。分别于麻醉诱导前（T0）、麻醉诱导后1min（T1）、气管插管后即刻（T2）、气管插管后1min（T3）、3min（T4）及10min（T5）记录心率（HR）、收缩压（SP）、舒张压（DP）,并于T0、T1、T3时采集桡动脉血7ml,测定肾上腺素（Ad）和去甲肾上腺素（NA）的浓度。结果与T0比较,Ⅰ组在T2、T3时的HR、SP、DP明显升高（P〈0.05）;而Ⅱ组、Ⅲ组在T2、T3时的HR、SP、DP变化没有统计学意义（P〉0.05）;Ⅱ组与Ⅲ组的HR、SP、DP在T1-T5差异无统计学意义（P〉0.05）。Ⅰ组T3时血浆Ad和NA的浓度变化没有统计学意义（P〉0.05）,而Ⅱ、Ⅲ组血浆中Ad、NA浓度低于Ⅰ组（P〈0.05）。结论芬太尼3μg/kg复合艾司洛尔1mg/kg或利多卡因1mg/kg均可减轻高血压患者气管插管时的心血管反应。

Objective To compare the effect of fentanyl and esmolol or lidocaine in the prevention of cardiovascular response to tracheal intubation in patients with hypertension. Methods Sixty ASA Ⅰ or Ⅱ patients aged 40-65 years undergoing elective upper abdominal surgery under general anesthesia with tracheal intubation were randomly divided into three groups （20/group）. Group I received fentanyl （3 μg/kg）, Group Ⅱ received fentanyl （3 μg/kg） and esmolol （1 mg/kg）, whereas Group Ⅲ received fentanyl （3 μg/kg） and lidocaine （1 mg/kg） before induction of anesthesia. Anesthesia was induced with midazolam （0.05 mg/kg） and propofol （1.5 mg/kg） and tracheal intubation was facilitated with rocuronium （0.08mg/kg） in all the patients. Radial artery was cannulated. Systolic pressure （SP）, diastolic pressure （DP） and heart rate （HR） were continuously monitored and recorded before induction of anesthesia （T0, baseline）, 1 min after induction （T1）, immediately and 1, 3, 10 min after intubation （T2-T5）. Arterial blood samples were obtained at T0, T1 and T3 for determination of plasma concentration of adrenaline （Ad） and noradrenaline （NA）. Results SP, DP and HR were significantly decreased immediately after induction of anesthesia （T1） compared with baseline values at T0 in Group I （P〈0.05）, while plasma Ad and NA concentrations at T3 were of no statistic significance （P〉0.05） and HR was significantly increased at T2 （P〈0.05）.SP, DP and HR of Group Ⅱ and Ⅲ were not statistically increased at T2 and T3 （P〉0.05）. Indexes of Group Ⅱ and Ⅲ were of no statistic significance from T1-T5 （P〉0.05）. Conclusion Fentanyl （3 μg/kg） plus either esmolol （1 mg/kg） or lidocaine （1 mg/kg） can prevent cardiovascular response to tracheal intubation in patients with hypertension.