Eames W O, Rooke G A, Wu R S, Bishop M J
Department of Anesthesia/Operating Room Services, Department of Veterans Affairs Medical Center, Seattle, Washington 98108, USA.
Anesthesiology. 1996 Jun;84(6):1307-11. doi: 10.1097/00000542-199606000-00005.
Tracheal intubation frequently results in reversible bronchoconstriction. Propofol has been reported to minimize this response in healthy patients and in asthma patients, but may be unsuitable for hemodynamically unstable patients for whom etomidate may be preferable. The current study examined respiratory resistance after tracheal intubation after induction with either thiopental, etomidate, or propofol. A supratherapeutic dose of etomidate was used to test the hypothesis that the bronchoconstrictive response could be minimized by deep intravenous anesthesia.
Seventy-seven studies were conducted in 75 patients. Anesthesia was induced with either 2.5 mg/kg propofol, 0.4 mg/kg etomidate, or 5 mg/kg thiopental. Respiratory resistance was measured at 2 min after induction.
Respiratory resistance at 2 min was 8.1 +/- 3.4 cmH2O.1(-1).s (mean +/- SD) for patients receiving propofol versus 11.3 +/- 5.3 for patients receiving etomidate and 12.3 +/- 7.9 for patients receiving thiopental (P < or = 0.05 for propofol vs. either etomidate or thiopental).
Respiratory resistance after tracheal intubation is lower after induction with propofol than after induction with thiopental or after induction with high-dose etomidate.
气管插管常导致可逆性支气管收缩。据报道，丙泊酚可使健康患者和哮喘患者的这种反应降至最低，但可能不适用于血流动力学不稳定的患者，对于这类患者，依托咪酯可能更可取。本研究检测了硫喷妥钠、依托咪酯或丙泊酚诱导后气管插管的呼吸阻力。使用超治疗剂量的依托咪酯来检验通过深度静脉麻醉可使支气管收缩反应降至最低的假设。
对75例患者进行了77项研究。分别用2.5mg/kg丙泊酚、0.4mg/kg依托咪酯或5mg/kg硫喷妥钠诱导麻醉。诱导后2分钟测量呼吸阻力。
接受丙泊酚的患者诱导后2分钟的呼吸阻力为8.1±3.4cmH2O·1(-1)·s（平均值±标准差），接受依托咪酯的患者为11.3±5.3，接受硫喷妥钠的患者为12.3±7.9（丙泊酚与依托咪酯或硫喷妥钠相比，P≤0.05）。
丙泊酚诱导后气管插管的呼吸阻力低于硫喷妥钠诱导后或高剂量依托咪酯诱导后的呼吸阻力。
