艾司洛尔和芬太尼对高血压患者气管插管循环反应影响的研究

Effects of esmolol and fentanyl on the hemodynamic and catecholamine response to tracheal intubation in hypertensive patients

目的 :比较艾司洛尔和芬太尼对高血压患者气管插管时循环和儿茶酚胺反应的影响。方法 :将 6 0例美国麻醉医师协会 (ASA)分级标准 ～ 级且行气管插管全麻手术的高血压患者随机分为 4组 ,分别于插管前静脉注射生理盐水 (A组 )、 2 m g/ kg艾司洛尔 (B组 )、2 μg/ kg芬太尼 (C组 )和 2 mg/ kg艾司洛尔 +2 μg/ kg芬太尼 (D组 )。静脉给咪唑安定、阿曲库胺和异丙酚诱导插管。测定插管前后收缩压 (SAP)、舒张压 (DAP)、心率 (HR)、心率收缩压乘积 (RPP)及血浆去甲肾上腺素 (NA)和肾上腺素 (A)浓度。结果 :气管插管后 1min和3min,A组患者 SAP、DAP、HR、RPP、NA和 A均非常显著高于基础水平 (P<0 .0 5或 P <0 .0 1) ,B组患者NA和 C组患者 SAP插管后均明显升高 (P均 <0 .0 5 ) ,D组患者气管插管后 SAP、DAP、HR和 NA、A水平与基础值比较无明显差异 (P均 >0 .0 5 )。结论 :高血压患者气管插管有明显循环和应激反应 ,2 mg/ kg艾司洛尔或 2 μg/ kg芬太尼预处理仅能部分减少插管反应 ,联合应用 2 mg/ kg艾司洛尔和 2 μg/ kg芬太尼能完全抑制高血压患者插管时的循环和儿茶酚胺反应。

Objective: To compare effects of esmolol and fentanyl on the hemodynamic and catecholamine response to tracheal intubation in hypertensive patients. Methods: Sixty hypertensive patients were randomly allocated into one of four groups: the patients received 0 9% saline in group A, 2 mg/kg esmolol in group B, 2 μg/kg fentanyl in group C and 2 mg/kg esmolol combined with 2 μg/kg fentanyl in group D before intubation. Tracheal intubation was performed with 0 1 mg/kg midazolam, 0 6 mg/kg atracurium and 2 mg/kg propofol. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), heart rate (HR),ratepressure product (RPP), plasma noradrenaline (NA) and adrenaline (A) concentrations were measured before and after intubation. Results: SAP, DAP, HR, RPP, NA and A levels in group A at 1 and 3 minutes after intubation were significantly higher than the baseline values (all P <0 01). NA levels in group B and SAP in group C increased significantly after intubation (both P <0 05). The hemodynamics and catecholamine in group D after intubation were not significantly different from the baselines (all P >0 05). Conclusion: 2 mg/kg esmolol or 2 μg/kg fentanyl can partly reduce hemodynamic response to intubation and 2 mg/kg esmolol combined with 2 μg/kg fentanyl can completely attenuate the hemodynamic and catecholamine response in hypertensive patients.