摘要
目的 比较观察全麻病人气管插管前静脉给予艾司洛尔或用表面麻醉抑制插管反应时心率变异性 (HRV)的变化。方法 12 0例病人随机分为三组 ,每组 40例 ,Ⅰ组为艾司洛尔组 ,Ⅱ组为单纯喉气管表面麻醉 (LTA)组 ,Ⅲ组为口咽表面喷雾加LTA组。静注芬太尼 2 μg·kg-1,异丙酚 2mg·kg-1,维库溴铵 0 1mg·kg-1诱导插管。I组病人插管前 2min ,静注艾司洛尔 2mg·kg-1;Ⅱ组病人用喉镜暴露声门 ,用 1%地卡因 2 5ml行会厌、声门及气管内的表面麻醉 2min后再行插管 ;Ⅲ组病人于麻醉前清醒时 ,用 1%地卡因约 0 5ml作舌背、软腭、咽及喉部喷雾 ,其余操作均与Ⅱ组相同。结果 除Ⅰ组病人在插管即刻和插管后 1min心率明显低于Ⅱ、Ⅲ组外 (P <0 0 5 ) ,其它两组病人在插管前后血压、心率均无明显变化。HRV和LF在插管前后只有Ⅲ组保持不变 ,而Ⅰ、Ⅱ组病人在插管即刻、插管后 1min均显著高于Ⅲ组 (P <0 0 1)。Ⅲ组病人的LF/HF在插管即刻及插管后 1min出现明显降低 (P <0 0 5 ) ,与Ⅰ、Ⅱ组相比有显著性差异。结论 插管前静脉注射艾司洛尔不能抑制应激反应的产生 ;表面麻醉能从根本上抑制应激反应的发生 ,但在插入喉镜前仍需完善的口咽喉部局麻作保证。
Objective To observe the changes of heart rate variability(HRV) following intravenous esmolol and surface anesthesia during tracheal intubation Methods One hundred and twenty adult patients were randomly divided into three groups (n=40), group Ⅰ (Esmolol), group Ⅱ (laryngotracheal surface anesthesia), group Ⅲ (oropharynx and laryngotracheal surface anesthesia group) Tracheal intubation was induced with fentanyl 2μg kg -1 , propforl 2mg kg -1 and vecuronium 0 1 mg kg -1 Group Ⅰ : intravenous administration of esmolol 2mg kg -1 2min before endotracheal intubation Group Ⅱ: laryngotracheal spray with 1% tetracaine 2 5ml 2min before endotracheal intubation Group Ⅲ : spraying the back of tongue, soft palate, pharynx and larynx with 1% tetracaine 0 5ml, with other manipulation being similar to group Ⅱ In each group BP,HR, HRV, LF, HF and LF/HF and BIS parameters were recorded before induction, during intubation and 1,3,5 and 10min after intubation respectively Results In three groups BP remained unchanged Compared with that in group Ⅱ and Ⅲ, HR in group Ⅰ decreased significantly(P<0 05) HRV, LF and LF/HF increased markedly immediately after intubation and 1 min after intubation in group Ⅰ and Ⅱ as compared with those in group Ⅲ After intubation HF was kept stable in three groups Conclusion Intravenous administration of esmolol before intratracheal intubation can attenuate the cardiovascular response induced by the release of catechelomines, but can not depress the stress response effectively The surface anesthesia can block the afference of nerve impulse and inhibit the occurrance of stress reaction substantially, but in practical manipulation this effect should be ensured with satisfied oropharynx and laryngotracheal surface anesthesia
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2000年第11期645-648,共4页
Chinese Journal of Anesthesiology
关键词
艾司洛尔
心率变异性
表面麻醉
气管插管
Intubation,intratracheal
Esmolol
Anesthesia,local
Heart rate variability
