右美托咪定与艾司洛尔预防全麻气管插管血流动力学反应的比较

PREVENTION OF HEMODYNAMIC RESPONSE DURING TRACHEAL INTUBATION IN GENERAL ANESTHESIA:DEXMEDETOMIDINE VERSUS ESMOLOL

目的比较右美托咪定与艾司洛尔预防全麻气管插管血流动力学反应的效果。方法拟行气管插管全麻下非心脏手术病人120例,ASAⅠ~Ⅱ级,随机分为3组,各40例。D组麻醉诱导前10min泵注右美托咪定1μg/（kg·min）,E组麻醉诱导前3min泵注艾司洛尔2mg/kg,C组未给予任何药物。各组全麻诱导使用丙泊酚2mg/kg,琥珀胆碱2mg/kg,芬太尼3μg/kg。记录各组麻醉诱导前药物输注前（T_0）、输注完毕（T_1）、全麻诱导完毕（T_2）、插管即刻（T_3）及插管后3min（T_4）、5min（T_5）、10min（T_6）时的心率（HR）、平均动脉压（MAP）及脑电双频指数（BIS）值。结果 D组T_0~T_6时HR和MAP比较差异无显著性（P〉0.05）。T_0、T_1和T_6时3组HR和MAP比较差异无显著性（P〉0.05）;T_4、T_5时D组HR低于C组和E组（F=11.67、19.64,P〈0.05）;D组T_3~T_5时MAP低于C组和E组（F=12.48~20.86,P〈0.05）。3组BIS在T_2~T_6时均较T_0和T_1时明显下降（F=31.67~41.65,P〈0.05）;D组在T_1~T_6时BIS低于C组和E组（F=5.85~11.36,P〈0.05）。结论麻醉诱导前应用右美托咪定和艾司洛尔均可防治全麻插管时的血流动力学反应,但右美托咪定较艾司洛尔效果更好。

Objective To investigate the effect of dexmedetomidine versus esmolol on prevention of hemodynamic response during tracheal intubation in general anesthesia. Methods T_his study consisted of 120 patients scheduled surgery for noncardiac disease,ASA Ⅰ-Ⅱ,who were evenly randomized to three groups as groups D,E and C.T_he patients in group D received intravenous dexmedetomidine 1μg/（kg·min）10min before anesthesia induction;those in group E were given intravenous esmolol2mg/kg 3min before anesthesia induction;those in group C were not given any drugs before anesthesia induction.All the patients were intubated using propofol 2mg/kg,succinylcholine 2mg/kg and fentanly 3μg/kg.Heart rate（HR）,mean arterial pressure and BIS-before anesthesia induction and intravenous drug injection（T_0）,upon completion of drug injection（T_1）,upon completion of anesthesia induction（T_2）,immediately after intubation（T_3）and 3min（T_4）,5min（T_5）,and 10min（T_6）after intubation-were recorded. Results In group D,the differences in HR and MAP at T_0-T_6 were not significant（P〈0.05）.T_he differences in HR and MAP at T_0,T_1 and T_6among the three groups were not significant（P〉0.05）.At T_4-T_5,the HR in group D was lower than that in groups C and E（F=11.67,19.64;P〈0.05）,at T_3-T_5 the MAP in group D was lower than that in groups C and E（F=12.48-20.86,P〈0.05）.In the three groups,the BIS at T_2-T_6 was much lower than that at T_0-T_1,the differences being significant（F=31.67-41.65,P〈0.05）.At T_1-T_6,the BIS in group D was lower than that in groups C and E（F=5.85-11.36,P〈0.05）. Conclusion Both dexmedetomidine and esmolol to be used before anesthesia induction can control hemodynamic response during tracheal intubation in general anesthesia,but the effect of dexmedetomidine is better than esmolol.