卡托普利对全麻诱导气管内插管时循环反应的作用

Effects of captopril on intubation response during anesthesia induction

目的 探讨卡托普利静注预防全麻窥喉插管(LTI)循环副反应的效果及作用机制。方法 插管全麻30例患者随机分为两组,试验组(麻醉诱导前10min静注卡托普利0.30～0.35mg·kg^(-1)和对照组各15例。两组均以氟哌利多、芬太尼、硫喷妥钠及氯化琥珀胆碱诱导插管。于LTI前后不同时点测定收缩压(SP)、舒张压(DP)、心率(HR)、心率收缩压乘积(RPP)及血浆血管紧张素Ⅰ(AⅠ)、血管紧张素Ⅱ(AⅡ)、醛固酮(ALD)、去甲肾上腺素(NE)、肾上腺素(E)、心钠素(ANP)、血栓素B_2(TXB_2)的水平。结果 ①试验组LTI期间SP、DP、HR及RPP比较平稳;而对照组于插管即刻及其后1～1.5、3min上述指标明显升高(P<0.05或0.01)。②试验组插管即刻及其后1～1.5minAⅠ明显升高(P<001),AⅡ、ALD显著降低(P<0.05或0.01),NE、E、ANP插管期间及TXB_2插管后无明显变化;而对照组AⅠ、AⅡ及ALD各时点差异无显著性,NE、E插管即刻及其后1～1.5min及ANP、TXB_2插管即刻及其后1～1.5、5min明显升高(P<0.01)。且各内分泌指标组间差异亦显著(P<0.05或0.01)。结论 卡托普利0.30～0.35mg·kg^(-1)麻醉诱导前10min静注,可削弱LTI期间交感神经活动升高,能有效地预防LTI循环副反应。

Objective To investigate the effects of captopril on intubation response and the mechanism. Methods Thirty ASA Ⅰ - Ⅱ patients aged 25-60 yr, weighing 45-70 kg, scheduled for elective surgery under general anesthesia with tracheal intubation and mechanical ventilation were randomly divided into 2 groups: captopril group ( n = 15) and control group ( n = 13) . Premedication consisted of intramuscular phenobarbital 0.2 g and atropine 0.5 mg. In captopril group, captopril 0.3-0.35 mg·kg-1 was injected intravenously 10 min before induction while in control group normal saline 10 ml was given instead. Anesthesia was induced with droperidol 0.05 mg·kg-1 , fentanyl 1 μg·kg-1 , thiopentone 5-6 mg·kg-1 . Intubation was facilitated with succinylcholine 1.5 mg · kg-1 . Laryngoscopy and tracheal intubation was successfully performed within 30 seconds. Mechanical ventilation was started and enflurane inhalation was begun and maintained at 2.1 % , SBP, DBF, HR, EGG and SpO2 were continuously monitored. Blood samples were taken from peripheral vein before induction (T0 ) , at intubation (T1 ), 1-1.5 min (T2) and 5 min (T3) after intubation for determination of plasma concentrations of angiotensin- Ⅰ (A 1 ), angiotensin- Ⅱ (A Ⅱ ), aldosterone (ALD), noradrenaline (NE), adrenaline (E), atrial natriuretic polypeptide (ANP) and thromboxane B2(TXB2) .Results (1) In captopril group SBP, DBF, HR, and heart rate-systolic BP product (RPP) remained unchanged at intubation, while in control group the parameters were significantly increased at T1 or T2 as compared with the baseline values ( P < 0.05 or 0.01). (2) In captopril group plasma level of A Ⅰ was increased, plasma A Ⅱ and ALD levels were decreased and plasma NE, E, ANP and TXB2 concentrations remained unchanged at T1 or T2 as compared with the baseline values (T0) ; whereas in control group the plasma A Ⅰ , A Ⅱ and ALD concentrations remained unchanged at T1 ; plasma NE, E, ANP and TXB2 concentrations were increased at T1 or T2 as compared with the baseline values. There was significant difference in the endocrine response to laryngoscopy and intubation between the two groups (P < 0.05 or 0.01) Conclusion Captopril 0.3- 0.35 mg · kg-1 given iv 10 min before induction can effectively attenuate the hemodynamic and endocrine response to laryngoscopy and tracheal intubation.