气管插管时脑血管血液动力学变化及艾司洛尔的平抑作用

Cerebrovascular hemodynamics and the effects of esmolol during endotracheal intubation

目的 探讨气管插管对脑血管血液动力学的影响及艾司洛尔（ＥＳＭ）的平抑作用。方法 ９３ 例择期手术病人，随机分成：ＥＳＭ ０ｍ ｇ·ｋｇ－ １ 组（对照组）、ＥＳＭ １ｍ ｇ·ｋｇ－ １ 组、ＥＳＭ ２ｍ ｇ·ｋｇ－ １ 组，检测麻醉前、插管后１、５、１０ 分脑血管血液动力学指标（ＣＶＤＩ）及体循环血压、心率。结果 （１）与插管前相比，插管后平均脑血流速度（Ｖｍ ｅａｎ）、平均脑血流量（Ｑｍ ｅａｎ）、脑血管阻力比（Ｒｔ）、临界压力（Ｃｐ）显著增高（Ｐ＜ ００５）。其中Ｖｍ ｅａｎ 最高增加达７３４０％ 、Ｑｍ ｅａｎ 达５７９１％ 、Ｒｔ达１５１５％ ，而Ｃｐ 则达２３０４％ ；（２）静注ＥＳＭ 不改变ＣＶＤＩ指标增加的趋势（Ｐ＞ ００５）；（３）ＥＳＭ １ｍ ｇ·ｋｇ－ １或２ｍ ｇ·ｋｇ－ １ 能平抑气管插管所致的心率增加；静注ＥＳＭ ２ｍ ｇ·ｋｇ－ １，可在气管插管后１分明显降低其所致的收缩压升高，而ＥＳＭ １ｍ ｇ·ｋｇ－ １则无此效果。结论 全麻诱导气管插管，可引起脑血管血液动力学的有害性变化，静注ＥＳＭ 有较好的平抑心血管不良作用。

Objective To investigate the effects of esmolol (ESM) on cerebrovascular hemodynamic indices (CVDI) Methods Ninty three patients undergoing elective operation were divided into three groups randomly,group Ⅰ:ESM 0mg·kg -1 and group Ⅱ:ESM 1mg·kg -1 ,and group Ⅲ:ESM 2mg·kg -1 CVDI were detected before and 1,5 and 10 min after endotracheal intubation Results After endotracheal intubation,the mean cerebral blood velocity (Vmean),mean cerebral blood volume (Qmean),ratio of cerebrovascular resistance (Rt),and critical pressure (Cp),were significantly increased (P<0 05) The maximum increased level of Vmean was 73 40%,and that of Qmean was 57 91%,Rt 15 15%,Cp23 04% intravenous ESM changed the increasing trends of CVDI,but at the same time point among different groups,CVDI had no statistical significant differences (P>0 05);ESM inhibited the heart rate increasing resulted from endotracheal intubation;During the induction period,intravenous ESM 2mg·kg -1 ,played a significant inhibiting role in the peak of systolic pressure but intravenons ESM 1mg·kg -1 did not produce the same effect Conclusion During the induction period,intravenous ESM 2mg·kg -1 can inhibit the side effects on cardiovascular reflex,but can not inhibit the cerebrovascular stress resulted from endotracheal intubation