摘要
目的观察全身麻醉诱导时静脉注射氯普鲁卡因对气管插管过程中机体应激反应的影响，并探讨其量效关系。方法选择ASAⅠ-Ⅱ级、行择期气管插管全身麻醉腹部手术患者60例，随机分为四组：C_1、C_2组（诱导分别静脉注射氯普鲁卡因3．0、4．5mg／kg），L组（诱导静脉注射利多卡因1．5mg／kg），F组（诱导静脉注射芬太尼3μg／kg），每组15例。记录所有患者诱导前、置入喉镜前及插管后0．5、1、3、5min心率（HR）、平均动脉压（MAP）、心率变异指数（RRP），并于诱导前、插管后3min和10min采集外周静脉血，检测血浆肾上腺素及血清皮质醇浓度。结果C_2组插管后0．5、1min时HR和插管后1、3min时MAP显著低于同时点C_1组、L组和F组（P〈0．05），插管后3min时HR显著低于同时点L组和F组（P〈0．05）。C_1组插管后0．5、1min时HR和插管后1min时MAP低于同时点L组和F组（P〈0．05）。C_2组插管后3min时血浆肾上腺素浓度显著低于C_1组、L组和F组（P〈0．05），C_2组显著低于L组（P〈0．05）。C_2组插管后10min时血清皮质醇浓度显著低于L组和F组（P〈0．05）。结论氯普鲁卡因静脉注射可有效抑制全身麻醉气管插管过程中机体的应激反应，且4．5mg／kg优于3．0mg／kg。
To compare the effects of chloroprocaine, lidocaine and fentanyl with intravenous injection on stress responses associated with endotracheal intubation during general anesthesia. Methods Sixty patients scheduled for abdominal surgery with endotracheal intubation under general anesthesia were randomly divided into four groups of 15 each. C_l and C_2 groups（ chloroprocaine, 3 mg/kg and 4.5 mg/kg respectively） , L group （lidocaine, 1.5 mg/kg） , and F group （fentanyl, 3 μg/ kg） ,all of the patients were injected with above mentioned medicines before endotracheal intubation. Heart rate（HR） and mean artery pressure （MAP） were recorded before inducement （TO ）and inserting laryngoscopy（T_1）, at 0.5, 1, 3 and 5 min （T_2, T_3, W_4, T_5 ）after intubation. Blood samples were analyzed before inducement, and at 3, 10 min after intubation for plasma epinephrine （E） and serum eortisol （Cor） concentrations. Results HR at T_2 , T_3 and MAP at T_3 , T_4 were significantly lower in the C_2 group compared with other three groups （ P 〈 0.05 ） , and HR at T_4 were also significantly lower in the C_2 group than that in L and F groups（ P 〈 0.05 ）. HR at T_2 , T_3 and MAP at T_3 were significantly lower in the C_1 group compared with L and F groups （ P 〈 0.05 ）. Plasma concentrations of E were significantly lower in the C_2 group at 3 min after intubation than in other three groups （ P 〈 0.05 ） , meanwhile those were significantly lower in the C_1 group compared with L group（ P 〈 0.05 ）. Serum concentrations of Cor were also significantly lower in the Cz group at 10 min after intubation compared with L and F groups （P 〈0.05 ）. Conclusion The intravenous injection of chloroprocaine before intubation can effectively restrain stress response induced by inserting laryngoscopy and endotracheal intubation, and this effect was more pronounced when 4.5 mg/kg compared with 3.0 mge/kg.
出处
《中国急救医学》
CAS
CSCD
北大核心
2012年第3期203-205,共3页
Chinese Journal of Critical Care Medicine
关键词
氯普鲁卡因
气管插管
应激反应
抑制
Chloroprocaine
Endotracheal intubation
Stress response
Restrain
