Hassan H G, el-Sharkawy T Y, Renck H, Mansour G, Fouda A
Department of Surgery, Faculty of Medicine, University of Kuwait.
Acta Anaesthesiol Scand. 1991 Jul;35(5):442-7. doi: 10.1111/j.1399-6576.1991.tb03325.x.
To study the relationship between the intensity of the stimulus exerted against the base of the tongue during direct laryngoscopy and the magnitude of associated hemodynamic and catecholamine responses, a study was conducted in 40 ASA I or II patients. Laryngoscopy lasting 40 s was performed with a size 3 Macintosh blade connected to a force-displacement transducer. The intensity of the stimulus exerted during laryngoscopy is expressed by the product of its average force (N) and duration (s) and given as impulse in Ns. Highly significant relationships were found between the impulse during laryngoscopy and the maximal hemodynamic and catecholamine responses. Also, when laryngoscopy was followed by orotracheal intubation, significant relationships were found with steeper slopes of the regression lines for systolic blood pressure, heart rate and plasma epinephrine concentrations. A more rapid regression of hemodynamic data was seen in intubated patients, whereas their plasma catecholamine concentrations regressed more slowly. The mechanisms of the responses to laryngoscopy and orotracheal intubation are proposed to be by somato-visceral reflexes. Stimulation of proprioceptors at the base of the tongue during laryngoscopy induces impulse-dependent increases of systemic blood pressure, heart rate and plasma catecholamine concentrations. Subsequent orotracheal intubation recruits additional receptors that elicit augmented hemodynamic and epinephrine responses as well as some vagal inhibition of the heart.
为研究直接喉镜检查时作用于舌根的刺激强度与相关血流动力学及儿茶酚胺反应幅度之间的关系，对40例美国麻醉医师协会（ASA）I或II级患者进行了一项研究。使用连接有力-位移传感器的3号麦金托什喉镜叶片进行持续40秒的喉镜检查。喉镜检查期间施加的刺激强度用其平均力（牛顿）与持续时间（秒）的乘积表示，并以牛顿秒为单位的冲量给出。研究发现喉镜检查期间的冲量与最大血流动力学及儿茶酚胺反应之间存在高度显著的关系。此外，当喉镜检查后进行经口气管插管时，收缩压、心率和血浆肾上腺素浓度的回归线斜率更陡，存在显著关系。插管患者的血流动力学数据回归更快，而其血浆儿茶酚胺浓度回归更慢。推测喉镜检查和经口气管插管反应的机制是通过体-内脏反射。喉镜检查期间对舌根本体感受器的刺激会引起与冲量相关的全身血压、心率和血浆儿茶酚胺浓度升高。随后的经口气管插管会激活额外的感受器，引发增强的血流动力学和肾上腺素反应以及对心脏的一些迷走神经抑制。
