倍他乐克对高血压患者全麻气管拔管时心血管反应的影响(2)
我们将不同剂量倍他乐克用于接受拔管的患者,观察到同样的结果,在拔管与拔管后10 min,其心率及基础值与拔管前相比,无显著升高,甚至有所减慢。而未用倍他乐克患者拔管时,心率显著上升,并持续到拔管后10 min,同时间点组间比较也有差异,这说明倍他乐克可有效的抑制拔管造成的心率上升。倍他乐克各组均能有效抑制心率增快,组间差异不明显,但它无法阻止拔管造成的交感神经活性增强,它对血压增高的抑制作用主要是通过减慢心率,降低心输出量这一途径。本研究观察到0.06 mg/kg组能预防血压上升,提示小剂量能控制心率上升,而需较大剂量才能控制血压的平稳。D组有2例在给药3 min后出现,心动过缓(心率>50/min),均无特殊处理,后恢复正常。提示术前心率不快的患者不宜用大剂量的倍他乐克, 以免发生严重的心动过缓或心跳骤停。因此0.04 mg/kg倍他乐克用于拔管的患者可以起到降低心肌耗氧, 预防心肌缺血的效果,可提高围拔管期患者的安全性。
[参考文献]
[1]TakeshimaK,Noda K,Higaki M.Cardiovascular response to rapid anesthesia Induction and endotracheal intubation[J]. Anesth Analg,l994,43:201-208.
[2]Stoelting RK.Circulatory changes during direct laryngoscopy and endotracheal Intubation[J].Anesthesiology,l997,47:381-384.
[3]谢柏章.实用麻醉技术[M].上海:上海科学技术出版社,2001:444-449.
[4]Mikaua K,Nishna H,Maekaua N,et al.Attenuation of cardiovascular responses to tracheal extubation:verapamil versus diltiazen[J].Anesth Analg,1996,82:1205-1222.
[5]Lowrie A,Johnston PL,Fell D,et al.Cardiovascu]az and plasma catecholamine responses at tracheal extubation[J].Br JAnaesth,1992,68:216-223.
(收稿日期:2009-04-22), 百拇医药
[参考文献]
[1]TakeshimaK,Noda K,Higaki M.Cardiovascular response to rapid anesthesia Induction and endotracheal intubation[J]. Anesth Analg,l994,43:201-208.
[2]Stoelting RK.Circulatory changes during direct laryngoscopy and endotracheal Intubation[J].Anesthesiology,l997,47:381-384.
[3]谢柏章.实用麻醉技术[M].上海:上海科学技术出版社,2001:444-449.
[4]Mikaua K,Nishna H,Maekaua N,et al.Attenuation of cardiovascular responses to tracheal extubation:verapamil versus diltiazen[J].Anesth Analg,1996,82:1205-1222.
[5]Lowrie A,Johnston PL,Fell D,et al.Cardiovascu]az and plasma catecholamine responses at tracheal extubation[J].Br JAnaesth,1992,68:216-223.
(收稿日期:2009-04-22), 百拇医药