艾司洛尔与阿片类药联合应用对原发性醛固酮增多症患者手术气管插管和拔管时血流动力学的影响

Effects of Esmolol on Hemodynamic Changes during Intubation and Extubation in Patients Undergoing Laparoscopic Adrenal Tumors Resection

目的观察艾司洛尔与瑞芬太尼或舒芬太尼联合应用对原发性醛固酮增多症患者气管插管和拔管时血流动力学的影响。方法将48例ASAⅡ级择期行腹腔镜下肾上腺肿瘤切除术患者随机分为2组：瑞芬太尼（Remif）组和舒芬太尼（Suf）组．．Remif组：诱导给予瑞芬太尼0．5Ixg／kg，维持给予瑞芬太尼0．1μg·kg^-1·min^-1持续泵注。Suf组诱导给予舒芬太尼0．1μg／kg，维持给予舒芬太尼0．02μg·kg^-1·min^-1持续泵注，复合七氟醚1．5％～2．5％，氧气空气比1：1维持，插管及拔管前5min均静脉注射艾司洛尔0．5mg／kg，术中艾司洛尔10μg·kg^-1·min^-1持续泵注。监测2组患者麻醉前、插管、拔管及术中血流动力学指标。结果Retail组插管后与麻醉前比较心率无明显变化，插管后1min和3min血压明显升高（P〈0．05），5min恢复正常。拔管时心率血压无明显变化。Suf组插管后与麻醉前比较心率无明显改变，血压明显下降（P〈0．05）；拔管后心率、血压均无明显改变。在插管后0，3，5min，Remif组平均动脉压明显高于Suf组（P〈0．05）。结论在肾上腺肿瘤切除手术中，艾司洛尔与舒芬太尼合用更能有效抑制插管时血压波动，提供更好的血流动力学稳定性。

Objective To observe the effects of esmolol on hemodynamic changes during intuabtion and exlubation in patients undergoing lapmvscopic adrenal tumors resection. Methods Forty-eight patients with ASA Ⅱ undergoing laparoscopic adrenal tumors resection were randomly divided into two groups：group Remif and group Suf. group Remif received 0.5μg·kg^-1 remifentanil when induced and 0.1 μg·kg^-1·min^-1 during anesthesia. Group Suf received sufentanil 0.1μg·kg^-1 when induced and 0.02 μg·kg^-1·min^-1 during anesthesia. Both the two groups were maintained with sevoflm＇ane 1.5%-2.5%. All patients were given esmolo] bolus injection of 0.5 mg/kg at 5rain before intubation and extubation and continuous infusion at a rate of 10μg·kg^-1·min^-1 until the end of anesthesia .Heart rate （HR） and mean artery pressure （MAP）were recorded at baseline at 1 min, 3 min and 5 min after intubation and extubafion. Results There were no statistically significant differences in sex, age and body weight between the two groups. In group Remif, MAP increased obviously at 1min and 3 min after intuba- fion （P 〈 0.05 ）,but decreased to basehne values after 5 min,there were no statistically differences in HR during intubation and after extuba- tion. In group Suf,MAP decreased obviously at 1,3 and 5 rain after intubation （P 〈 0.05 ）. There were no obviously changed in MAP and HR in group Remif and Suf after extubation. Conclusion Esmolol companying with sufentanil could inhibit the response to intubation and extubation,and supply better hemodynamic stability than that of group Remif.