【摘要】 目的  比較瑞芬太尼、丙泊酚、艾司洛爾用于支撐喉鏡手術氣管插管時患者的心血管反應。 方法  選取2009年1-3月就診的60例擬于全身麻醉下行擇期支撐喉鏡下聲帶息肉切除術的患者，隨機分為丙泊酚組、艾司洛爾組和瑞芬太尼組，每組20例。麻醉誘導采用咪達唑侖、芬太尼和丙泊酚，患者意識消失后給予琥珀膽堿。1 min后各組分別給予丙泊酚2 mg/kg、艾司洛爾1 mg/kg和瑞芬太尼1 μg/kg。30 s后進行氣管插管。記錄患者誘導前及插管前、插管后1、3、5 min的心率和血壓水平。 結果  各組插管前的收縮壓和心率較誘導前明顯降低，插管后1、3 min的收縮壓和心率較插管前升高（P lt;0.05)。丙泊酚組和艾司洛爾組插管后的收縮壓較瑞芬太尼組升高（P lt;0.05)。丙泊酚組插管后心率較瑞芬太尼組增加（P lt;0.05)。 結論  對行支撐喉鏡手術的患者，氣管插管前30 s給予1 μg/kg瑞芬太尼較2 mg/kg丙泊酚和1 mg/kg艾司洛爾能更有效地減輕氣管插管時的血流動力學反應。
【Abstract】 Objective  To assess the different effects of remifentanil, propofol, and esmolol on hemodynamic responses during intubation in CO2 laser endolaryngeal microsurgery (CO2-LELM). Methods  A total of 60 patients aged from 18 to 65 years, admitted from January to March 2009 and scheduled to undergo elective CO2-LELM under general anesthesia for treatment of vocal cord polyp were randomly assigned to a propofol group, an esmolol group, and a remifentanil group. Anesthesia was induced with midazolam (0.015-0.02 mg/kg), fentanyl (1 μg/kg), and propofol (1 mg/kg). After the patients became unconscious, succinylcholine (1 mg/kg) was given one minute later. Then the patients in the three groups received propofol (2 mg/kg), esmolol (1 mg/kg), and remifentanil (1 μg/kg), respectively. Intubation was performed 30 secconds later. Heart rate (HR) and systolic blood pressure (SBP) were measured noninvasively before general anesthesia induction (baseline, Tb), just before intubation(Ti), and one, three, and five minutes after intubation (T1, T3, T5). Results  The demographic data including age, sex and body weight were comparable in the three groups. Tracheal intubation caused significant increases in SBP and HR in all groups compared with Ti (P lt;0.05). After intubation, SBP in the propofol group and the esmolol group were significantly higher than that in remifentanil group (P lt;0.05), and HR in the propofol group was significantly higher than that in the remifentanil group (P lt;0.05). Conclusion  In patients with CO2-LELM, remifentanil (1 μg/kg) administrated 30 seconds before intubation is maximal effective compared with propofol (2 mg/kg) or esmolol (1 mg/kg) in attenuating the hemodynamic responses to oraltracheal intubation.

Citation： LUuml,Peilin,CHEN Guo. Comparison of the Effects of Remifentanil，Propofol and Esmolol on Hemodynamic Responses During Intubation in CO2 Laser Endolaryngeal Microsurgery. West China Medical Journal, 2010, 25(9): 1701-1703. doi: Copy

Copyright ? the editorial department of West China Medical Journal of West China Medical Publisher. All rights reserved