前列腺素E1可减轻气管拔管引起的高血压反应。

Prostaglandin E1 attenuates the hypertensive response to tracheal extubation.

作者信息

Nishina K, Mikawa K, Shiga M, Maekawa N, Obara H

机构信息

Department of Anaesthesiology, Kobe University School of Medicine, Japan.

出版信息

Can J Anaesth. 1996 Jul;43(7):678-83. doi: 10.1007/BF03017950.

DOI:10.1007/BF03017950

PMID:8807172

Abstract

PURPOSE

Tracheal extubation causes hypertension and tachycardia, which may cause imbalance between myocardial oxygen demand and supply in patients at risk of coronary artery disease. We conducted a randomized, controlled study to evaluate the effects of 0.05 or 0.1 microgram.kg-1.min-1 prostaglandin E1 (PGE1) iv on haemodynamic variables occurring during tracheal extubation and emergence from anaesthesia and compared them in patients receiving either lidocaine or saline.

METHODS

Eighty ASA physical status 1 patients undergoing elective surgery were enrolled in the current study. Anaesthesia was maintained with sevoflurane 1.0%-2.5% (ET concentration) and nitrous oxide 60% in oxygen. Muscle relaxation was achieved with vecuronium. The patients were randomly assigned to receive one of four treatments (n = 20 each): saline (control), 0.05 microgram.kg-1.min-1 PGE1, 0.1 microgram.kg-1.min-1 PGE1, or 1 mg.kg-1 lidocaine. PGE1 was infused from completion of surgery until five minutes after tracheal extubation. Changes in heart rate (HR) and blood pressure (BP) were measured during and after tracheal extubation.

RESULTS

In the control group, the HR, systolic BP, and diastolic BP increased during tracheal extubation. Administration of 0.1 microgram.kg-1.min-1 PGE1 and 1 mg.kg-1 lidocaine attenuated the increases in BP although 0.05 microgram.kg-1.min-1 PGE1 failed to do so. The inhibitory effect of the 0.1 microgram.kg-1.min-1 PGE1 on BP was similar to that of lidocaine 1 mg.kg-1 iv. The increase in HR was attenuated by lidocaine but not by PGE1.

CONCLUSION

The intravenous infusion of 0.1 microgram.kg-1.min-1 PGE1 given during emergence from anaesthesia and tracheal extubation is a useful method for attenuating the hypertension associated with noxious stimuli during this period.

摘要

目的

气管拔管可导致高血压和心动过速，这可能会使有冠状动脉疾病风险的患者心肌氧供需失衡。我们进行了一项随机对照研究，以评估0.05或0.1微克·千克⁻¹·分钟⁻¹的前列腺素E1（PGE1）静脉注射对气管拔管和麻醉苏醒期间血流动力学变量的影响，并在接受利多卡因或生理盐水的患者中进行比较。

方法

80例美国麻醉医师协会（ASA）身体状况为1级的择期手术患者纳入本研究。麻醉维持采用1.0% - 2.5%（呼气末浓度）的七氟醚和60%的氧化亚氮与氧气混合。使用维库溴铵实现肌肉松弛。患者被随机分配接受四种治疗之一（每组n = 20）：生理盐水（对照组）、0.05微克·千克⁻¹·分钟⁻¹ PGE1、0.1微克·千克⁻¹·分钟⁻¹ PGE1或1毫克·千克⁻¹利多卡因。PGE1从手术结束后开始输注，直至气管拔管后5分钟。在气管拔管期间及之后测量心率（HR）和血压（BP）的变化。

结果

在对照组中，气管拔管期间HR、收缩压和舒张压升高。给予0.1微克·千克⁻¹·分钟⁻¹ PGE1和1毫克·千克⁻¹利多卡因可减轻血压升高，尽管0.05微克·千克⁻¹·分钟⁻¹ PGE1未能做到。0.1微克·千克⁻¹·分钟⁻¹ PGE1对血压的抑制作用与静脉注射1毫克·千克⁻¹利多卡因相似。HR的升高被利多卡因减轻，但未被PGE1减轻。