术前静脉注射艾司洛尔对行食管异物取出术患者应激反应的影响

Effect of intravenous infusion of esmolol on stress reaction in patients undergoing removal of esophageal foreign body

目的探讨术前静脉注射艾司洛尔对行食管异物取出术患者应激反应的影响。方法选择60例在全身麻醉下行食管异物取出术的患者,采用随机数字表法将患者分入艾司洛尔组和对照组,每组30例。在麻醉诱导前,艾司洛尔组静脉注射艾司洛尔0.5mg/kg,对照组静脉注射等量的0.9%氯化钠溶液,两组麻醉诱导均依次静脉注射咪达唑仑0.02mg/kg、依托咪酯0.3mg/kg、芬太尼4μg/kg,之后予阿曲库铵0.6mg/kg,气管插管后以丙泊酚麻醉维持。记录麻醉诱导前(T_0)、气管插管即刻(T_1)、手术开始时(T_2)、手术结束时(T_3)和气管拔管即刻(T__4)各时间点患者的平均动脉压(MAP)和心率。于T_0至T_4时间点采集静脉血,置于抗凝管内,测定血浆去甲肾上腺素(NE)、肾上腺素、皮质醇和血糖水平。结果对照组在T_1至T_4时间点的MAP、心率、NE、肾上腺素、皮质醇和血糖水平均显著高于同组T_0时间点和艾司洛尔组同时间点(P值均<0.05)。结论在麻醉诱导前静脉注射艾司洛尔0.5mg/kg可以抑制行食管异物取出术的患者因麻醉、手术操作引起的应激反应,且患者术中血流动力学更平稳。

Objective To explore the effect of intravenous infusion of esmolol on stress reaction in patients undergoing removal of esophageal foreign body. Methods Sixty patients scheduled for removal of esophageal foreign body under general anesthesia were randomly divided into two groups （n = 30 each）. Before anesthesia induction, 0.5 mg/kg esmolol was intravenously injected in esmolol group, and the same volume of normal saline was given intravenously in control group. The general anesthesia was inducted by intravenous injection of 0.02 mg/kg midazolam, 4 μg/kg fentanyl, 0.3 mg/kg etomidate and 0.6 mg/kg atracurium. And the anesthesia was maintained by propofol after tracheal intubation. Mean arterial pressure （MAP）, heart rates （HR）, and plasma concentrations of norepinephrine （NE）, epinephrine （E）, cortisol （Cor） and glucose （Glu） were recorded at the following time points： before induction （To）, at the beginning of intubation （T1）, at the beginning of surgery （T2）, immediately at the end of surgery （T3）, and extubation （T4）. Results MAP, HR, NE, E, Cor and Glu at T1, T2, T3 and T4 in the control group were significantly higher than those at To in the control groUp and those at T1, T2, T3 and T4 in the esmolel group （all P〈0.05）. Conclusion Intravenous infusion of 0.5 mg/kg esmolol before anesthesia induction can effectively inhibit stress reaction caused by anesthesia and operation in patients undergoing removal of esophageal foreign body. Stable hemodynamics can be kept during surgery.