地尔硫卓、尼卡地平用于预防气管插管期心血管反应的研究

Comparison of Diltiazem and Nicardipine for controlling the cardiovascular responses to tracheal intubation

目的:观察地尔硫卓、尼卡地平预防气管插管期心血管反应的疗效。方法:将60例ASAⅠ～Ⅱ级的成年患者随机分为生理盐水组(C组)、尼卡地平15μg/kg组(N组)、地尔硫卓0.2 mg/kg组(D组)。在气管插管前2 min静脉推注。记录诱导前、给药时、给药后、气管插管时及插管后1、2、3 min的血压(BP)、心率(HR)、心搏指数(SVI),心指数(CI),计算心率收缩压乘积(RPP=心率×收缩压)。结果:插管后C组平均动脉压(MAP)、HR的峰值较基础值上升21.7%、31.1%(P<0.01);D组插管后MAP、HR均无明显增高,变化小于C组(P<0.05);N组插管后MAP无显著变化,但HR的峰值较基础值升高42.5%。静注地尔硫卓、尼卡地平后CI、SVI较给药前增加。结论:尼卡地平可减轻气管插管的升压反应,但不能防止心动过速的发生;地尔硫卓可有效抑制气管插管时的心血管不良反应。

Objective： To observe the efficacy of Nicardipine and Diltiazem in attenuation the cardiovascular responses to laryngoscopy and tracheal intubation（LTI）.Methods： 60 patients of ASA Ⅰ-Ⅱ were assigned to one of the following 3 groups at random,normal saline（group C）,0.2 mg/kg Diltiazem（group D） or 15 μg/kg Nicardipine（group N）.The medication for study was administered intravenously 2 minutes before the initiation of LTI.Blood pressure（BP）,heart rate（HR）,stroke volume index（SVI） and cardiac index（CI） were recorded at designed time points,before induction,immediate and after the bolus injection,immediate and 1,2,3 min after LTI.Rate-pressure product（RPP） were calculated.Results： After intubation,the peak MAP and HR values in group C increased by 21.7% and 31.1% over the baseline values（P0.01）;changes of MAP and HR after tracheal intubation in group D were less than those in group C（P0.05）;In group N,the increase in MAP provoked by LTI were less than group C and HR increased by 42.5% over the baseline;CI,SVI increased slightly after the bolus of Diltiazem and Nicardipine.Conclusion： Nicardipine is effective in attenuating pressure response to tracheal intubation but can not prevent tachycardia;Diltiazem produced greater attenuation on the circulatory responses to tracheal intubation.