艾司洛爾與硝酸甘油合用對吸痰患者心血管反應的預防

[摘要] 目的 探討艾司洛爾復合硝酸甘油滴鼻對吸痰患者心血管副反應的預防作用。方法 80例氣管切開患者隨機均等分為對照組、艾司洛爾組、硝酸甘油組及艾司洛爾復合硝酸甘油組。記錄給藥前、給藥后、吸痰即刻及吸痰后1、5min各時段SBP、DBP、HR的變化。結果 在吸痰期，艾司洛爾組患者心率變化與對照組比較明顯降低（P＜0.01），血壓變化與對照組比較略降低，但無差異；硝酸甘油組患者血壓較平穩，與對照比較心率變化無顯著性差異（P＜0.01）；艾司洛爾復合硝酸甘油組血壓、心率均明顯較對照組平穩（P＜0.01）。結論 吸痰前1min靜注1.5mg/kg艾司洛爾，加吸痰前3min滴鼻0.2%硝酸甘油4μg/kg可以抑制吸痰時發生的心血管副反應。

[關鍵詞] 艾司洛爾； 硝酸甘油； 心血管副反應； 預防

[中圖分類號] R472 [文獻標識碼] A [文章編號] 1673-9701（2009）13-07-03

Esmolol Combined and Nitroglycerin Suction on the Response of Patients with Cardiovascular Prevention

SUN Lina1 WANG Senlin2 ZHANG Chengming1 ZHANG Rui1 MA Jun1

1.Department of Anesthesiology，Weifang Medical University，Shandong 261042；2.Department of Neurosurgery，Changyi People's Hospital，Shandong 261300

[Abstract] ObjectiveTo explore the prevention role of composites esmolol nitroglycerin in patients with nasal suction on the cardiovascular side effects. Methods80 cases of tracheotomy patients were randomly divided into two equal in the control group，esmolol group，the nitroglycerin group and esmolol composite nitroglycerin group. The change of the SBP，DBP and HR of the administration before delivery，suction and immediately after the suction 1，5min were recorded. ResultsIn the suction period，esmolol patients heart rate decreased significantly compared with the control group（P＜0.01），compared with the control of blood pressure changes slightly lower，but no differences in blood pressure in patients with nitroglycerin group more stable，compared with the control（P＜0.01）， no difference in heart rate；Esmolol composite group of nitroglycerin blood pressure and heart rate were stable than the control group（P＜0.01）. Conclusion1min before the suction 1.5mg/kg intravenous esmolol，plus pre-suction 3min nose 0.2% nitroglycerin 4μg/kg when the suction can inhibit cardiovascular side effects.

[Key Words]Esmolol； Nitroglycerin； Cardiovascular reaction； Prevention

氣管插管實施機械通氣或氣管切開患者排盡吸出氣管內分泌物，保持呼吸道通暢是非常重要的。但吸痰引起的循環反應對于心腦血管疾病患者有一定的潛在危險，可引起缺氧或低氧血癥、氣管痙攣、心律失常、血壓變化、顱內壓上升及氣道損傷[1]。為了有效預防這種副反應，現對艾司洛爾和（或）鼻滴硝酸甘油對吸痰時心血管反應的影響報道如下。

1 材料與方法

1.1 一般資料

2007年7月～2008年5月濰坊醫學院附屬醫院80例氣管麻醉患者，其中男48例，女32例；年齡24～75歲；體重40～70kg；無低血壓、心力衰竭者，吸痰前血壓、心率、心電圖和電解質均正常。

1.2 方法

所有病例隨機分為四組，各20例。對照組常規吸痰；艾司洛爾（山東齊魯制藥股份有限公司7030021EF）組：吸痰前1min靜注1.5mg/kg艾司洛爾；……