硫酸镁、利多卡因对冠心病患者全麻诱导期间血液动力学的影响

 目的 比较不同剂量舒芬太尼及复合使用利多卡因或硫酸镁对冠心病患者全麻诱导期间血液动力学的影响，以探讨更加适合冠心病患者全麻诱导的药物组合。方法 择期行非体外循环冠脉旁路移植术患者80例，年龄52~76岁，体重49~87 kg，美国麻醉医师协会（ASA Ⅱ级或Ⅲ级，左室射血分数≥45%。根据麻醉诱导用药情况分为4组：复合硫酸镁组（MS组、复合利多卡因组（LS组、小剂量舒芬太尼组（S1组和大剂量舒芬太尼组（S2组。MS组和LS组在静注总量（0.08 mg·kg-11/3的咪达唑仑后分别缓慢静注硫酸镁20 mg·kg-1和利多卡因1.5 mg·kg-1，然后静注余量的咪达唑仑和舒芬太尼0.6 μg·kg-1；S1组和S2组在静注总量（0.08 mg·kg-11/3的咪达唑仑后分别缓慢注射舒芬太尼0.6和0.9 μg·kg-1，然后静注余量的咪达唑仑，当脑电双频谱指数（BIS降至75时给予哌库溴铵，经面罩加压供氧3 min行气管插管。记录病人入室麻醉前（基础值、麻醉用药后气管插管前、气管插管后即刻、1、3、5、8 min的收缩压（SBP、舒张压（DBP、平均动脉压（MAP和心率（HR。并记录各组心血管不良事件的发生情况和需要药物干预的病例数。结果 与基础值相比，在麻醉诱导后气管插管前4组血压均明显降低，S2组降低幅度最大。气管插管后4组血压均回升，其中S1组增加明显（P<0.05，且与另外3组相比差异显著（P<0.05。插管后3至8 min所有病人血压逐渐回降，MS、ML和S1组的血压低于基础值，但仍在临床允许范围，而S2组下降显著，尤其在插管后8 min，与另外3组比较差异显著（P<0.05，P<0.01。除S2组以外，另外3组插管前心率下降不明显，插管后即刻至1 min仅S1组心率显著增加（P<0.05，在插管5 min后S2组心率继续下降（P<0.05。气管插管前S2组发生低血压和心动过缓的病例明显多于另外3组，插管后S1组高血压和心动过速的病例则明显多于MS、LS和S2组。结论 以较小剂量舒芬太尼（0.6 μg·kg-1复合硫酸镁（20 mg·kg-1或利多卡因（1.5 mg·kg-1可明显缓和冠心病患者插管前低血压，并减少插管刺激引起的高血压和心动过速，有利于血液动力学的稳定。

Effects of Lidocaine and Magnesiun Sulfate on Hemodynamic Parameters During Anesthesia Induction in Patients with Coronary Artery Disease

OBJECTIVE To compare the effects of magnesium and lidocaine with that of sufentanil for prevention of hypotension pre- endotracheal intubation or tachycardia and hypertension caused by endotracheal intubation. METHODS Eighty patients (aged 52-76 years， weighing 49-87 kg， ASA Ⅱ or Ⅲ， EF≥45% were randomized into four equal groups. Anesthesia was induced with midazolam 0.08 mg·kg-1， and followed by sufentanil 0.6 μg·kg-1 (group S1 or 0.9 μg·kg-1 (group S2， or sufentanil 0.6 μg·kg-1 combined with magnesiun sulfate 20 mg·kg-1 (group MS or lidocaine 1.5 mg·kg-1 (group LS. Tracheal intubation was facilitated with vecuronium 0.12 mg·kg-1. Heart rate (HR and arterial pressure (SBP， DBP and MAP were recorded before and after induction of anaesthesia， immediately after intubation， and 1， 3， 5， and 8 min after intubation. RESULTS The four groups were comparable with respect to age， sex， body weight， and duration of tracheal intubation. Compared with the other three groups， SBP， DBP and MAP decreased significantly in group S2 (P<0.05. While HR， SBP， DBP and MAP increased significantly in group S1 immediately after intubation and 1 min after intubation (P<0.05， but the increase was less than that in other groups. In group S2 there was a significant decrease in arterial pressure 5 min after intubation， but the decrease was less than that in other groups (P<0.05，P<0.01. More patients were treated due to tachycardia and hypertesion in group S1， and hypotension in group S2. CONCLUSION Administration of magnesiun sulfate (20 mg·kg-1 or lidocaine (1.5 mg·kg-1 3 min before intubation can prevent tachycardia and arterial pressure increase caused by laryngoscopy and tracheal intubation， and can be beneficial for stablizing hemodynamic parameters during anesthesia induction.