艾司洛尔对高血压冠心病患者围拔管期应激反应的影响

The Influences of esmolol on Patients with hypertension and coronary heart Diseas between the extubation period

目的：观察艾司洛尔对高血压冠心病患者围拔管期应激反应的影响。方法：选择择期行开胸手术合并高血压冠心病患者50例，将患者随机分入艾司洛尔组（A组）和对照组（N组），每组25例。所有患者均采用气管插管全身麻醉。在符合拔管条件后A组静脉注射艾司洛尔1.5mg/kg,N组静注等量生理盐水，用药后2min拔除气管导管。记录术前（T1）、给药前（T2）、给药后（T3）、拔管即刻（T4）、拔管后1min（T5）、拔管后5min（T6）、拔管后10min（T7）共7个时间点HR、MAP、RPP。于T1、T4、T6时点采集外周血标本5mL，酶联免疫分析法测定各时点血浆去甲肾上腺素（NE）和肾上腺素（E）浓度，放免法测定皮质醇（Cor）浓度。结果：T3～T7时N组HR、MAP、RPP明显高于T1时和A组（P＜0.05）。T4、T6时N组E、NE、Cor明显高于T1时和A组（P＜0.05）。结论：在高血压冠心病患者手术围拔管期应用艾司洛尔能有效地预防拔管所致心血管反应，同时能抑制应激反应，对于合并高血压冠心病的患者更为有益。

Objective：To investigate the influences of esmolol on Patients with hypertension and coronary heart diseas between the extubation period.Methods：50 cases with hypertension and coronary heart diseas underwent chest surgery were randomly divided into control group（n=25,group N）and experiment group（n=25,group A）.Group A received esmolol 1.5mg/kg infusion for 2 minutes before extubation.While group N received the same amount of saline.Before operation（T1）,before and after the intravenous infusion of esmolol（T2、T3）,before extubation（T4）,after extubation 1,5,10min（T5、T6、T7）,HR 、MAP and RPP were recorded ,the levels of plasma epinephrine（E）,norepinephri ne（NE）,cortisol（COR） were determined.Results：HR、MAP and RPP of group N at T5~T7 were significantly higher than those at T1 and those of group A（P〈0.05）.E、NE and Cor of group N at T4、T6 were significantly higher than those at T1 and those of group A（P〈0.05）.Conclusion：Esmolol can inhibite the stress response caused by tracheal extubation on patients with hypertension and coronary heart diseas.