Jin Yun yu, Yang Lan, Zhu Sai nan, Pan Zhen Yu, Bai Yu, Fan Zhi yi
Department of Anesthesia, Beijing Cancer Hospitalì Peking University School of Oncology, Beijing Institute for Cancer Research, Beijing 100036, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2008 Apr;40(2):192-4.
To observe the relationship between the level of catecholamine in plasma with bispectral index during endotracheal intubation with propofol anesthesia in order to investigate the mechanism of the preventing of endotracheal intubation response with esmolol.
Thirty patients were randomly allocated into two groups: control group (n=15) and esmolol group (n=15). The patients received esmolol 1amg/kg followed by 250 microg/(kgdmin) in esmolol group and saline in control group. Two minutes later, the patients received propofol 2amg/kg for induction. Bispectral index (BIS), systolic pressure (SP), diostolic pressure (DP), and heart rate (HR) were measured before endotracheal intubation and 3amin after intubation, at the same time 8a mL arteral blood was taken for the measurement of the concentrations of norephinephrine(NE) and ephinephrine(E) in plasma.
The level of BIS(63.53+/-3.11), NE(2.016+/-0.681)and E(0.578+/-0.072)in control group 3 min after endotracheal intubation were increased significantly than those before intubation (P<0.05), but there were no significant change in the level of BIS, NE and E in esmolol group 3amin after endotracheal intubation . There were significant differences in the concentrations of NE(2.016+/-0.681)and E(0.578+/-0.072) in plasma 3 min after intubation between the two groups (P< 0.05) and there were also significant differences in BIS(63.53+/-3.11) and DeltaBIS(20.93+/-4.57)3 min after intubation between the two groups(P<0.01). SP( 148+/-20)and HR(89+/-180) in control group were increased after intubation than those before intubation (P<0.05) . There were no significant differences in SP, DP and HR in esmolol group after intubation than those before intubation.
Esmolol can reduce the plasma concentrations of NE and E through preventing periopheal sympathetic nerve response to intubation and can reduce BIS arousal reactions after endotracheal intubation.
观察异丙酚麻醉下气管插管期间血浆儿茶酚胺水平与脑电双频指数（BIS）的关系，以探讨艾司洛尔预防气管插管反应的机制。
将30例患者随机分为两组：对照组（n = 15）和艾司洛尔组（n = 15）。艾司洛尔组患者先静脉注射艾司洛尔1mg/kg，随后以250μg/（kg·min）持续输注，对照组输注生理盐水。两分钟后，两组患者均静脉注射异丙酚2mg/kg进行诱导。分别于气管插管前及插管后3分钟测量脑电双频指数（BIS）、收缩压（SP）、舒张压（DP）和心率（HR），同时采集动脉血8ml，测定血浆去甲肾上腺素（NE）和肾上腺素（E）浓度。
对照组气管插管后3分钟时BIS（63.53±3.11）、NE（2.016±0.681）和E（0.578±0.072）水平较插管前显著升高（P < 0.05），而艾司洛尔组气管插管后3分钟时BIS、NE和E水平无明显变化。两组插管后3分钟时血浆NE（2.016±0.681）和E（0.578±0.072）浓度比较差异有统计学意义（P < 0.05），两组插管后3分钟时BIS（63.53±3.11）及BIS变化值（ΔBIS，20.93±4.57）比较差异有统计学意义（P < 0.01）。对照组插管后SP（148±20）和HR（89±18）较插管前升高（P < 0.05）。艾司洛尔组插管后SP、DP和HR与插管前比较差异无统计学意义。
艾司洛尔可通过抑制围术期交感神经对插管的反应，降低血浆NE和E浓度，减轻气管插管后的BIS觉醒反应。
