艾司洛尔和尼莫地平预防气管插管反应的观察

Observation of Preventive Effects of Esmolol and Nimodipine on Stress Responses to Endotracheal Intubation

目的:探讨单独或联合应用艾司洛尔和尼莫地平预防气管插管反应的效果。方法:神经外科择期手术全麻病人74例,ASAⅠ～Ⅱ级,随机分为4组。芬太尼0.002mg/kg、潘库溴胺0.1mg/kg、异丙酚2mg/kg诱导后分别给予生理盐水5ml(C组),艾司洛尔1mg/kg(E组),尼莫地平0.01 mg/kg(N组),或艾司洛尔0.5mg/kg+尼莫地平0.005mg/kg(E+N组)。分别于诱导前、后,插管后即刻及1、2、3分监测SBP、DBP、HR,并计算RPP。结果:C组插管即刻SBP、DBP、HR、RPP分别较基础值上升15.8%、14.1%、24%和44.3%。E组插管后SBP、DBP、RPP的升高幅度与C组无显著差异,但HR无明显增快。N组插管后SBP、DBP无显著变化,但HR明显上升。E+N组插管后SBP、DBP和HR均无升高反应。结论:全麻诱导后单独应用艾司洛尔可抑制心率增快,但不能防止血压升高;单独予尼莫地平可抑制血压升高,但心率增快;二者联合应用可有效抑制气管插管的心血管副反应。

Objective:To observe the effects of esmolol and nimodipine on the cardiovascular responses to endotracheal intubation. Methods: Seventy-four ASA Ⅰ orⅡ patients undergoing elective neurosurgery with general anesthesia were divided into group C,E,N and E+N randomly. After induction with fantanyl (0.002 mg/kg),pancuronium (0.1 mg/kg) and propofol (2 mg/kg),normal saline (5 ml) was given in group C as control, esmolol (1 mg/kg) in group E,nimodipine (0.01 mg/ kg) in group N,and esmolol (0.5 mg/kg) plus nimodipine (0.005 mgAg) in group E+ N respectively. Before and after in-duction, immediately and 1,2,3 minutes after intubation, systolic blood pressure (SBP), diastolic blood pressure (DBF), heart rate (HR) and rate pressure product (RPP) were measured or calculated. Results:Compared with baseline value,SBP, DBP, HR and RPP immediately after intubation in group C increased by 15.8% , 14.1 % ,24.0% and 44.3% respectively. In group E,SBP,DBP and RPP after intubaion increased significantly,but HR did not increase. Although SBP and DBP in group N did not increase,HR increased obviously. In group E+ N,SBP,DBP,HR and RPP did not increase after intubation. Conclusion: After induction, the single use of esmolol or nimodipne can only attenuate HR or BP response to endotracheal in-tubation respectively. The combination of esmolol and nimodipine can prevent the HR and BP responses.