不同剂量纳布啡对老年高血压患者清醒气管插管应激反应的影响
摘要
目的探讨不同剂量纳布啡对老年高血压患者清醒气管插管应激反应的影响。方法选取择期拟行清醒气管插管手术原发性高血压患者45例,随机分为N1、N2、C组各15例。在麻醉诱导前30 min,N1、N2组分别经静脉注射纳布啡0.1、0.2 mg/kg,C组注射等量0.9%氯化钠溶液。分别记录3组在用药前(T_0)、局部麻醉前(T_1)、气管插管前(T_2)、气管插管后1 min(T_3)、气管插管后5 min(T_4)的平均动脉压(MAP)、心率(HR),同时分别检测血浆去甲肾上腺素(NE)、肾上腺素(E)、IL-6及IL-10。结果与T_0相比,N2组中MAP在T_1、T_2、T_4均降低(P<0.05);C组和N1组中MAP在T_2和T_4降低(P<0.05);N1组和C组MAP在T_3均升高(P均<0.05)。与C组相比,N2组在T_1～T_4时MAP均降低(P均<0.05);而N1与C组相比MAP各时点差异无统计学意义(P均>0.05)。与T_0相比,N2组中HR在T_1、T_2、T_3、T_4均明显减慢(P均<0.05);N1组和C组中HR在T_2、T_4明显减慢,在T_3则增快(P<0.05)。与C组相比,N2组中HR在T_1～T_4均明显减慢(P均<0.05);而N1组HR在各时点与C组相比差异均无统计学意义(P均>0.05)。与T_0相比,T_1时N2组NE和E值均降低(P均<0.05);而T_2时3组NE和E值均降低(P<0.05);T_3、T_4时C、N1组NE和E值升高(P<0.05),N2组升高不明显。与C组相比,N2组在T_1、T_2、T_3、T_4时, NE和E值均降低(P均<0.05);T_1～T_4时,N2组IL-6水平较C组和N1组显著降低(P<0.05),而IL-10水平较C组和N1组显著增高(P<0.05)。结论纳布啡0.2 mg/kg静脉注射可抑制老年高血压患者清醒气管插管引起的应激反应,降低炎性反应,维持清醒气管插管期间循环功能稳定。
引文
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[10] 史创国,薛荣亮.右美托咪啶对气管插管期心血管应激反应的影响[J].中国现代医药杂志,2018,20(1):18-21.
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[13] Ahsan-ul-Haq M,Kazmi EH.Nalbuphine prevents haemodynamic response to endotracheal intubation[J].J Coll Physicians Surg Pak,2005,15(11):668-670.
[14] Chawda PM,Pareek MK.Effect of nalbuphine on haemodynamic response to orotracheal intubation[J].J Anaesthesiol Clin Pharmacol,2010,26(4):458-460.
[15] Khan FA.Pharmacological agents for preventing morbidity associated with the haemodynamic response to tracheal intubation[J].Cochrane Database Syst Rev,2013,3(7):CD004087.
[16] 段凤梅,孙旭颖,许乃欣,等.纳布啡超前镇痛对老年开胸手术患者围术期炎性细胞因子的影响[J].实用医学杂志,2016,32(14):2259-2261.
[2] Howell SJ,Sear JW.Hypertension,hypertensive heart disease and perioperative cardiac risk[J].Br J Anaesth,2004,92(4):570-583.
[3] 王倩,屈昕,黄艺文.右美托咪定改善老年患者全身麻醉术后认知功能障碍的分子机制研究[J].中华实用诊断与治疗杂志,2019,33(1):78-82.
[4] 赵倩,王晓亮,方兆晶,等.超声引导下喉上神经阻滞在清醒经口气管插管中的应用[J].临床麻醉学杂志,2017,33(10):949-952.
[5] van den Berg AA,Halliday EM,Soomro NA,et al.Reducing cardiovascular responses to laryngoscopy and tracheal intubation:a comparison of equipotent doses of tramadol,nalbuphine and pethidine,with placebo[J].Middle East J Anaesthesiol,2004,17(6):1023-1036.
[6] Zeng Z,Lu J,Shu C,et al.A comparision of nalbuphine with morphine for analgesic effects and safety:meta-analysis of randomized controlled trials[J].Sci Rep,2015,3(5):10927.
[7] 陈睿,胡松,靳秋露,等.老年高血压血压变异性与靶器官损伤相关性研究进展[J].青岛大学学报(医学版),2018,54(6):743-746.
[8] 邬峻峰.丙泊酚在高血压患者全身麻醉诱导中的应用效果及其对血压的影响[J].临床合理用药杂志,2018,11(3):81-82.
[9] 吴雅娟,任建光,蔡迪盛,等.丙泊酚复合不同剂量瑞芬太尼对老年高血压患者全麻诱导应激反应的影响[J].现代中西医结合杂志,2017,26(33):3656-3659,3742.
[10] 史创国,薛荣亮.右美托咪啶对气管插管期心血管应激反应的影响[J].中国现代医药杂志,2018,20(1):18-21.
[11] Maguire AM,Kumar N,Parker JL,et al.Comparison of effects of remifentanil and alfentanil on cardiovascular response to tracheal intubation in hypertensive patients[J].Br J Anaesth,2001,86(1):90-93.
[12] Khan FA.Comparison of fentanyl and nalbuphine in total intravenous anaesthesia (TIVA)[J].J Pak Med Assoc,2002,52(10):459-465.
[13] Ahsan-ul-Haq M,Kazmi EH.Nalbuphine prevents haemodynamic response to endotracheal intubation[J].J Coll Physicians Surg Pak,2005,15(11):668-670.
[14] Chawda PM,Pareek MK.Effect of nalbuphine on haemodynamic response to orotracheal intubation[J].J Anaesthesiol Clin Pharmacol,2010,26(4):458-460.
[15] Khan FA.Pharmacological agents for preventing morbidity associated with the haemodynamic response to tracheal intubation[J].Cochrane Database Syst Rev,2013,3(7):CD004087.
[16] 段凤梅,孙旭颖,许乃欣,等.纳布啡超前镇痛对老年开胸手术患者围术期炎性细胞因子的影响[J].实用医学杂志,2016,32(14):2259-2261.