阿芬太尼和艾司洛尔对气管插管时循环和儿茶酚胺反应的影响

Effect of alfentanil and esmolol on hemodynamic and catecholamine response to tracheal intubation

目的 比较阿芬太尼和艾司洛尔对气管插管时循环及儿茶酚胺反应的影响。方法 35例病人随机分为 3组 ,A组为对照组 ,B组为艾司洛尔组 ,C组为阿芬太尼组。插管前 B、C组分别给予2 mg/ kg艾司洛尔、30μg/ kg阿芬太尼。静注硫喷妥钠和维库溴铵诱导插管。结果 插管后 3分 ,阿芬太尼组收缩压显著降低 (P<0 .0 1) ,B、C两组的心率低于对照组 (P<0 .0 5 )。 A、B两组的血浆去甲肾上腺素浓度 (NE)增加 ,均高于其基础值 (P<0 .0 1) ,但阿芬太尼组 NE水平无明显改变 ,肾上腺素水平较基础值降低 (P<0 .0 1)。结论 艾司洛尔 2 mg/ kg可在一定程度上缓解插管时的循环反应。阿芬太尼 30μg/ kg能完全抑制插管时的循环及儿茶酚胺反应。

Objective To compare the effect of alfentanil and esmolol on hemodynamic and catecholamine response to tracheal intubation Methods Thirty five adult patients were randomly allocated into one of three groups:A group (control group),B group (esmolol group) and C group (alfentanil group) The patients received 2 mg/kg esmolol in B group and 30 μg/kg alfentanil in C group before intubation Tracheal intubation was performed with 4 mg/kg thiopental and 0 1mg/kg vecuronium and 3% isoflurane Systolic pressure (SР),heart rate (HR),plasma norepinephrine (NE),epinephrine (E) and dopamine (DA) concentrations were measured with high performance liquid chromatography before and after intubation Results SP in C group 3 min after intubation was significantly lower than the baseline (P<0 01) HR in B group 2 min after intubation increased significantly but HR in B and C groups 3 min after intubation were significantly lower than that in control group (P<0 05) NE level in A and B groups increased significantly 3 min after intubation (P<0 01) NE level in C group 3min after intubation was not significantly different from the baseline but E level decreased significantly (P<0 01) Conclusion 2 mg/kg esmolol can reduce hemodynamic response to intubation to a certain extent and 30μg/kg alfentanil can completely attenuate the hemodynamic and catecholamine responses