右美托咪定与依托咪酯复合静脉利多卡因对气管插管时血流动力学反应的比较：一项随机对照研究。

Comparison of the hemodynamic response of dexmedetomidine versus additional intravenous lidocaine with propofol during tracheal intubation: a randomized controlled study.

机构信息

Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchatewi, Bangkok, 10400, Thailand.

出版信息

BMC Anesthesiol. 2021 Oct 30;21(1):265. doi: 10.1186/s12871-021-01484-6.

BACKGROUND

Laryngoscopy and tracheal intubation are strong stimuli that cause a reflex increase in blood pressure (BP), heart rate (HR), and serum catecholamine level. These can lead to myocardial infarction or cerebrovascular accidents. The purpose of this study is to compare the efficacy of dexmedetomidine and lidocaine combined with propofol in attenuating the hemodynamic response following laryngoscopy and endotracheal intubation.

METHODS

This study was a randomized controlled study and adhered to the CONSORT guidelines. One-hundred and six patients undergoing elective general anesthesia with endotracheal intubation were divided randomly into two groups. Group D received dexmedetomidine (1 μg kg) before induction. Group LP received lidocaine (1.5 mg kg) before induction with additional propofol (0.5 mg kg) before laryngoscopy. The primary endpoint was hemodynamic including systolic (S) BP, diastolic (D) BP, mean arterial blood pressure (MAP) and HR measured before and after induction and ≤ 10 min after intubation. Secondary outcome was complications/adverse effects.

RESULTS

After induction, the mean SBP, DBP, MAP and HR decreased significantly from baseline in both groups except for mean HR in group LP at 1 min. Differences in mean values of SBP, DBP, and MAP were significantly lower in group D after intubation at 4-10 min (P < 0.05). Group LP had a non-inferior effect in blunting BP at all time points except 1 and 2 min after induction, and 2 min after intubation. The mean difference in HR in group D was significantly lower than that in group LP at all time points (P < 0.001). Group D had significantly more episodes of bradycardia (18.87% vs. 0%, P = 0.001) and hypotension (52.83% vs. 15.09%, P < 0.001) than did group LP.

CONCLUSION

Lidocaine (1.5 mg kg) with additional propofol (0.5 mg kg) had a non-inferior effect compared with dexmedetomidine (1 μg kg) in attenuating the hemodynamic response following laryngoscopy and endotracheal intubation, and had fewer adverse effects.

TRIAL REGISTRATION

Thai Clinical Trial Registry, ( TRTC20190206002 ). Retrospectively registered 4 February 2019.

背景

喉镜检查和气管插管是强烈的刺激因素，会引起血压（BP）、心率（HR）和血清儿茶酚胺水平的反射性增加。这些可能导致心肌梗死或脑血管意外。本研究的目的是比较右美托咪定和利多卡因联合异丙酚在减轻喉镜检查和气管插管后血流动力学反应方面的效果。

方法

这是一项随机对照研究，符合 CONSORT 指南。106 例择期全身麻醉行气管插管的患者随机分为两组。D 组在诱导前给予右美托咪定（1μg/kg）。LP 组在诱导前给予利多卡因（1.5mg/kg），并在喉镜检查前给予异丙酚（0.5mg/kg）。主要终点是包括收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）和 HR 在内的血流动力学，在诱导前后和插管后≤10 分钟测量。次要结果是并发症/不良反应。

结果

诱导后，两组 SBP、DBP、MAP 和 HR 均较基础值显著下降，但 LP 组在插管后 1 分钟时 HR 除外。D 组在插管后 4-10 分钟时 SBP、DBP 和 MAP 的平均值明显低于 LP 组（P<0.05）。LP 组在除诱导后 1 和 2 分钟及插管后 2 分钟外的所有时间点均有非劣效性降压作用。D 组的 HR 平均值明显低于 LP 组，所有时间点均有统计学差异（P<0.001）。D 组心动过缓（18.87% vs. 0%，P=0.001）和低血压（52.83% vs. 15.09%，P<0.001）的发生率明显高于 LP 组。