尼卡地平预防气管插管期心血管反应的研究

1、 Diltiazem、尼卡地平预防气管插管期心血管反应的研究首都医科大学附属天坛医院麻醉科 100050于斌 王保国【目的】比较diltiazem、尼卡地平预防气管插管期心血管反应的疗效。【方法】 选取ASA级，颅脑占位择期行开颅手术的患者60例，随机分为三组：生理盐水组（C组，n=20）、diltiazem 0.2mg/kg组（D组，n=20）、尼卡地平15g/kg组(N组，n=20）。术前静注咪唑安定0.04mg/kg、长托宁1 mg。依次静注芬太尼2g/kg、异丙酚2mg/kg、维库溴铵0.1mg/kg麻醉诱导。2min后随机静注研究用药，1min内注完，4min后明视下气管插管。气管插

2、管后接呼吸机以潮气量810ml/kg，呼吸频率12次/min纯氧行机械通气，氧流量为1L/min。每组分别于诱导前、诱导后2min、给药后、气管插管即刻、插管后1、2、3、5 min记录患者的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）、脉搏氧饱和度(SpO2)、搏指数（SVI），心指数（CI）、收缩功能指数（HI）、总外周阻力（TPR），并计算心率收缩压乘积(RPP=SBP×HR)，监测心电图（ECG）的动态变化。插管5min后吸入12%异氟烷维持麻醉。【结果】插管后1min C组MAP 、HR、RPP分别较基础值上升19%、24.7%、44.7%（P&l

3、t;0.01）。插管期间D组MAP、RPP、HR均无明显增高，且分别低于C组。插管期N组MAP无显著变化，HR、RPP的升高幅度与C组无显著差异。诱导后三组CI、SVI、HI均低于基础值，而静注diltiazem、尼卡地平后三者均略有回升。插管期间D、N组三者的变化均大于C组。其中，D组SVI及N组CI的变化与C组相比有统计学意义。【结论】与静注尼卡地平相比，插管前2min静注0.2mg/kg 的diltiazem不仅能降低气管插管所致的血压升高，还可在一定程度上抑制插管时引起的心率增快，能更全面、有效地抑制气管插管期的心血管反应。对异丙酚、芬太尼诱导后轻度抑制的心脏，静注diltiazem、

4、尼卡地平后不影响心肌收缩性，心指数、搏指数增加，临床应用安全有效。【关键词】Diltiazem；尼卡地平；气管插管；心血管反应ABSTRACTComparison of Diltiazem and Nicardipine for Controlling the Cardiovascular Responses to Tracheal IntubationObjective: Laryngoscopy and tracheal intubation (LTI) often provoke an undesirable increase in blood pressure (BP) and/or

5、heart rate (HR). This study was undertaken to compare the efficacy of two calcium channel blockers, nicardipine and diltiazem, in attenuating the cardiovascular responses to LTI. Methods: Sixty ASA III patients undergoing elective intracranial surgery received, in a randomized, double-blind manner,

6、0.9%NS (Group C, n=20), 0.2mg/kg diltiazem (Group D, n=20) or 15g/kg nicardipine (Group N, n=20) two minutes before the initiation of laryngoscopy. Anaesthesia was induced with propofol 2mg/kg i.v., fentanyl 2g/kg i.v., vecuronium 0.1mg/kg i.v. LTI were attempted 4 minutes after administration of pr

7、opofol. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), stroke volume index (SVI), cardiac index (CI), heather's index (HI), total peripheral vascular resistance (TPR) were recorded before induction, 2 min after induction, after the b

8、olus injection, immediate at LTI, 1, 2, 3 and 5min after LTI. Rate-pressure product (RPP) was calculated at each time according to the formula, RPP=HR*SBP. Results: One minute after intubation, the MAP, HR, RPP values differed from the pre-induction baseline values by 19%, 24.7%, 44.7%, respectively

9、 (P<0.01). The changes from pre-induction in MAP, HR, RPP responsed to tracheal intubation in group D were less than those in groups C (P<0.05). The increase in MAP provoked by LTI in group N was lower than that in group C (P<0.05). CI, SVI, HI decreased after induction, while increased sli

10、ghtly after the bolus injection of diltiazem and nicardipine. The changes of CI, SVI, HI in groups D and N were higher than those of group C during the period of tracheal intubation. Compared with group C, the change of CI in group N and the change of SVI in group D were significantly higher (P<0

11、.05).Conclusion: Compared with nicardipine, administration of diltiazem 0.2mg/kg produced greater attenuation on the circulatory responses to tracheal intubation. Even in the mild suppressed heart influenced by fentanyl and propofol, adminstraton of diltiazem and nicardipine didnt inhibit the cardic muscle contra