低剂量艾司洛尔与拉贝洛尔对喉镜检查和气管插管拟交感神经反应的减弱作用比较。
Comparison of esmolol and labetalol, in low doses, for attenuation of sympathomimetic response to laryngoscopy and intubation.
作者信息
Singh Sarvesh P, Quadir Abdul, Malhotra Poonam
机构信息
Department of Anaesthesia, J N Medical College, Aligarh, India.
出版信息
Saudi J Anaesth. 2010 Sep;4(3):163-8. doi: 10.4103/1658-354X.71573.
OBJECTIVE
The present study compared the efficacy of esmolol and labetalol, in low doses, for attenuation of sympathomimetic response to laryngoscopy and intubation.
DESIGN
Prospective, randomized, placebo controlled, double-blinded study.
SETTING
Operation room.
PATIENTS AND METHODS
75 ASA physical status I and II adult patients, aged 18-45 years undergoing elective surgical procedures, requiring general anesthesia and orotracheal intubation.
INTERVENTIONS
Patients were allocated to any of the three groups (25 each)-Group C (control)10 ml 0.9% saline i.v. Group E (esmolol) 0.5 mg/kg diluted with 0.9% saline to 10 ml i.v. Group L (labetalol) 0.25 mg/kg diluted with 0.9% saline to 10 ml i.v. In the control group 10 ml of 0.9% saline was given both at 2 and 5 min prior to intubation. In the esmolol group 0.5 mg/kg of esmolol (diluted with 0.9% saline to 10 ml) was given 2 min prior and 10 ml of 0.9% saline 5 min prior to intubation. In the labetalol group 10 ml of 0.9% saline was administered 2 min prior and 0.25 mg/kg of labetalol (diluted with 0.9% saline to 10 ml) 5 min prior to intubation. All the patients were subjected to the same standard anesthetic technique.
MEASUREMENTS
Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded prior to induction, at time of intubation and 1, 3, 5, and 10 min after intubation. Mean arterial pressure (MAP) and rate pressure product (RPP) were calculated. Abnormal ECG changes were also recorded.
RESULTS
Compared to placebo and esmolol (0.5 mg/kg), labetalol (0.25 mg/kg) significantly attenuated the rise in heart rate, systolic blood pressure, and RPP during laryngoscopy and intubation. However, the difference was not statistically significant among the values for DBP and MAP.
CONCLUSION
In lower doses, labetalol (0.25 mg/kg) is a better agent than esmolol (0.5 mg/kg) in attenuating the sympathomimetic response to laryngoscopy and intubation.
目的
本研究比较低剂量艾司洛尔和拉贝洛尔减轻喉镜检查和气管插管引起的交感神经兴奋反应的疗效。
设计
前瞻性、随机、安慰剂对照、双盲研究。
地点
手术室。
患者和方法
75例年龄在18至45岁之间、美国麻醉医师协会（ASA）身体状况分级为I级和II级、接受择期外科手术、需要全身麻醉和经口气管插管的成年患者。
干预措施
患者被分为三组（每组25例）——C组（对照组）静脉注射10ml 0.9%生理盐水；E组（艾司洛尔组）0.5mg/kg艾司洛尔用0.9%生理盐水稀释至10ml静脉注射；L组（拉贝洛尔组）0.25mg/kg拉贝洛尔用0.9%生理盐水稀释至10ml静脉注射。对照组在插管前2分钟和5分钟均给予10ml 0.9%生理盐水。艾司洛尔组在插管前2分钟给予0.5mg/kg艾司洛尔（用0.9%生理盐水稀释至10ml），在插管前5分钟给予10ml 0.9%生理盐水。拉贝洛尔组在插管前2分钟给予10ml 0.9%生理盐水，在插管前5分钟给予0.25mg/kg拉贝洛尔（用0.9%生理盐水稀释至10ml）。所有患者均采用相同的标准麻醉技术。
测量指标
在诱导前、插管时以及插管后1、3、5和10分钟记录心率（HR）、收缩压（SBP）和舒张压（DBP）。计算平均动脉压（MAP）和率压积（RPP）。记录异常心电图变化。
结果
与安慰剂和艾司洛尔（0.5mg/kg）相比，拉贝洛尔（0.25mg/kg）在喉镜检查和气管插管期间能显著减轻心率、收缩压和RPP的升高幅度。然而，舒张压和平均动脉压的值在各组间差异无统计学意义。
结论
在较低剂量下，拉贝洛尔（0.25mg/kg）在减轻喉镜检查和气管插管引起的交感神经兴奋反应方面比艾司洛尔（0.5mg/kg）更有效。
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