舒芬太尼复合艾司洛尔对全麻患者气管拔管时心血管反应的影响.DOCVIP

临床医学论文-舒芬太尼复合艾司洛尔对全麻患者气管拔管时心血管反应的影响 【摘要】? 目的评价舒芬太尼复合艾司洛尔对全麻患者气管拔管时心血管反应的影响。方法选择全麻择期手术成年患者120例，ASAⅠ~Ⅱ级，无明显心血管病史，随机分为两组(n=60)，A组:舒芬太尼0.5μg/kg；B组:舒芬太尼0.5μg/kg+艾司洛尔1 mg/kg。观测比较麻醉诱导前、插管后5 min、拔管后5 min 收缩压(SP)、舒张压(DP)和心率(HR)变化，并采集桡动脉血7ml， 测定血浆肾上腺素(Ad)和去甲肾上腺素(NA)的浓度。结果两组年龄、体重、ASA分级、并发症比较差异均无统计学意义(P 0.05)。与A组同一时点比较， B组HR、SP、DP及血浆Ad和NA的浓度降低(P0.05) 。A组插管后HR、SP、DP及血浆Ad和NA的浓度明显高于麻醉诱导前(P0.05)，持续至拔管后5 min；B 组拔管前后变化不明显(P 0.05)。结论舒芬太尼复合艾司洛尔可更好地预防全麻患者气管拔管时的心血管反应。 【关键词】? 麻醉 拔管 应激 　　Abstract： ObjectiveTo investigate the efficacy of sufentanil and esmolol in the prevention of cardiovascular response to extubation after general anesthesia. MethodsA total of 120 ASA I or II patients undergoing selective operation under general anesthesia were randomly divided into two groups (n=60/group). Group A was administered with sufentanil (0.5 μg/kg), and Group B with sufentanil (0.5 μg/kg) and esmolol (1 mg/kg). The parameters of systolic pressure (SP), diastolic pressure (DP), heart rate (HR), and concentrations of plasm adrenaline (Ad) and noradrenaline (NA) were compared between the two groups before induction, 5 min after endotracheal intubation and 5 min after extubation. ResultsThere were no significant differences in age, body weight, ASA class and complication between the two groups (P0.05). SP, DP, HR and the concentrations of Ad and NA were significantly lower in Group B than in Group A (P0.05). SP, DP, HR and the concentrations of Ad and NA were significantly higher after intubation than before induction in Group A (P0.05), which lasted until 5 min after extubation, but they were not statistically changed in Group B (P 0.05). ConclusionThe combination of sufentanil and esmolol can better prevent cardiovascular response to extubation after general anesthesia. 　　Key? words： anesthesia; extubation; stress 　　全麻气管拔管期间常常引起血浆儿茶酚胺浓度增加、血压升高、心率增快，使合并高血压、冠心病等高危因素病人麻醉危险性明显增加。而气管拔管时又不能通过加深全麻的方法来减轻应激反应的程度。许多药物如吸入麻醉药、交感神经阻滞药、血管扩张药、局部麻醉药、麻醉性镇痛药以及上述药物的结合被推荐应用于减轻气管插管反应［1］。艾司洛尔是一种新型药物，在国外已开始应用于临床麻醉，但国内目