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麻黄碱在全麻诱导期间对气管插管条件和血流动力学的效应返修稿件
The effect of ephedrine on Intubating conditions and hemodynamics during tracheal intubation

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DOI:
作者:
韩彬,郝雪梅
Hanbin Haoxuemei
作者单位:
沈阳市红十字会医院
the red cross hospical of shenyan
关键词:
麻黄碱；全麻诱导期间；气管插管的肌松条件；血流动力学
Ephedrine； during induction of anaesthesia； the intubating conditions； hemodynamics
摘要:
【摘要】目的：本实验旨在研究在用咪唑安定、舒芬太尼、异丙酚、非去极化肌松药维库溴铵全麻诱导期间，预先静注小剂量麻黄碱，观察气管内插管肌松条件和血流动力学的变化。方法：选择ASA I~II级全身麻醉气管内插管下行骨科手术的患者40人，随机分成2组，对照组(A组)、麻黄碱组(B组)，每组20人。麻醉诱导用药：A组依次静注咪唑安定0.03 mg/kg，0.9%氯化钠注射液，舒芬太尼0.5ug/kg，异丙酚1.5mg/kg；B组依次静注咪唑安定0.03 mg/kg，麻黄碱70ug/kg，舒芬太尼0.5ug/kg，异丙酚1.5mg/kg；各组诱导药物120秒内注毕。所有患者意识消失后启动加速度肌松监测仪，静注维库溴铵0.1mg/kg，分别记录各组麻醉诱导前，麻醉诱导后，气管插管前，气管插管后1分钟、3分钟和5分钟的心率（HR）、平均动脉压（MAP）等指标，分别评价各组气管插管的情况并记录各组肌松药起效时间。结果：比较基础值、诱导后、气管插管前、气管插管后3分钟及5分钟两组的HR、MAP相比较无统计学差异（P>0.05），只有在气管插管后1分钟B组相对A组有HR升高的趋势（P<0.05），B组85%的气管插管优秀率高于A组55%，肌松药起效时间B组较快。结论：麻醉诱导期间预注小剂量麻黄碱（70ug/kg），明显改善了非去极化肌松药维库溴铵气管插管的肌松条件，而无循环系统副作用。
Objective We compared the effect of pre-treatment with a small dose of ephedrine and saline on intubating conditions and haemodynamics during tracheal intubation using midazolam sufentanile propofol and vecuronium. Methods Forty ASA physical status 1 or 2 patients undergoing born surgeries under general anesthesia were include in the study.Exclusion criteria included any cardiovascular or neuromuscular disease as well as hepatic or rental impairment. Participating patients were randomly assigned to two groups: placebo group (group A ), ephedrine group (group B), 20 patients in each group, all were no preanesthetic medication. General endotracheal anaesthesia: Group A was induced with midazolam 0.03mg/kg, 0.9% saline,sufentanile 0.5ug/kg, propofol 1.5mg/kg. Group B was induced with midazolam 0.03mg/kg, ephedrine 70ug/kg, sufentanile 0.5ug/kg, propofol 1.5mg/kg. All drugs were injected in 120s. The neuromuscular block was assessed at the adductor pollicis using accelography after loss of consciousness. Vecurium was administered. Group A and group B are both injected 0.1mg/kg vecurium.The heart rather(HR), mean arterial pressure(MAP) were recorded in every period of time during anesthesia administration, such as preanesthesia, after induction, before endotracheal intubation and 1,3,5 min after intubating. Intubating conditions were rated by the intubator. The times of maximum block were recorded. Results There were no statistical differences in baseline HR and baseline MAP(P > 0.05). There were no statistical differences in HR and MAP after indused 、 before endotracheal intubating、 at 3 and 5 min after tracheal intubation (P > 0.05). But only group B experienced marked tachycardia at 1 min after tracheal intubation （p<0.05）. There was a significantly higher proportion of intubating conditions graded as 'excellent' in group B(85%) than in group A (55%) (p < 0.05). The onset time of vecuronium in group B is quicker than in group A. Conclusion A low dose of ephedrine（70ug/kg）was given during induction of anaesthesia improves the intubating conditions of vecuronium ,the nondepolarizing neuromuscular blocking agent(NNBA), while without significant adverse hemodynamic clinical effects.

 

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