不同剂量艾司洛尔预防双腔支气管内插管时心血管反应的临床研究

Effect of different dosage esmolol on inhibit endobronchial intubated cardiovascular response

目的观察不同剂量的艾司洛尔对预防双腔支气管内插管时心血管反应的临床效果及合适剂量。方法选择ASAⅠ～Ⅱ级开胸手术患者60例，随机分为三组，每组20人。A组：注射生理盐水10ml（对照组），B组：静脉注射艾司洛尔0．5mg／kg，C组：静脉注射艾司洛尔1mg／kg，记录麻醉诱导前（基础值）、诱导后2min、插管后即刻、插管后2min、5min、10min的收缩压（SBP）、舒张压（DBP）、心率（HR），计算各对应时点HR和收缩压（SBP）的乘积（RPP）。结果与基础值相比，诱导后2min三组SBP、DBP、HR和RPP均较基础值显著降低（P〈0．05），B组降低的程度比A组更甚，但不及c组低；气管插管后即刻，A组、B组的SBP、DBP、HR和RPP显著升高（P〈0．05），但B组增高的程度明显低于A组（P〈0．05），而C组保持稳定；插管后2min、5min、10min三组SBP、DBP、HR和RPP随时间逐渐趋于基础值，但B、C组仍低于A组（P〈0．05）。结论应用0．5mg／kg和1mg／kg两种剂量的艾司洛尔均能有效抑制双腔支气管内插管引起的心血管反应，但1mg／kg艾司洛尔为合适剂量，且血流动力学稳定。

Objective To study the suitable dosage and clinical efficacy of esmolol on inhibiting endobronchial intubated cardiovascular response. Methods Sixty ASA Ⅰ-Ⅱ patients who undergoing thoracic surgery were randomly allocated to one of three groups（20 per group）to receive：0.9% sodium chloride 10 ml （ groupA）, esmolol 0.5 mg/kg（ group B ）, esmolol 1 mg/kg（ groupC ）. The systolic blood pressure （ SBP）, dias- tolic blood pressure（DBP） and heart rate（HR） were recorded and rate-pressure product（RPP） were calculated before induction （baseline） ,2 min after induction, and at instantly,2 min,5 min and 10 min after intubation. Results SBP,DBP,HR,RPP were significantly decreased 2 min after induction of anesthesia as eompared to the baseline values in all 3 groups （ P 〈 0. 05 ）, while immediately after induction SBP, DBP, HR, RPP were significantly increased in group A and B, The intubation responses were strongest in group A, and least in group C, SBP,DBP,HR,RPP reached their highest values significantly later and returned to baseline level after intubation. Conclusion 1 mg,/kg esmotol both can inhibit the endobronehial intubated cardiovascular response, but mylky more effectively than 0. 5 mg/kg esmolol and it can also keep the hemodynamics steady.